Thursday, May 05, 2005

Dead Dog

Three calls today. An old lady with a headache, an industrial worker with a gashed chin and a chest pain. While we were taking care of the old lady there was a bad MVA in town where the driver's dog was killed when the driver hit a tree. He was alive, but not in the best of shape. Good thing for seat belts.


I got an interesting email today about a new study that shows morphine may cause more harm than good in chest pain patients.

Morphine for chest pain worsens death risk-study

The study can be accessed through the link below:

American Heart Journal article pdf

One of the most interesting aspects of being in EMS now almost seventeen years is how medicine continues to change. As a kid, I used to laugh at the story of how George Washington died because they bled him to death, thinking they were letting the evil humours out, and how they used to put leeches on people. But every year it turns out that things we think are good, may not be -- they are in fact the equivilent of putting leeches on someone or bleeding them to death.

EMS, like much of modern medicince is trying to become more evidence based, and do things not because we think they might work, but because studies prove they work.

One area that has come under attack has been what is called RSI, for rapid sequence intubation, where a patient who needs an airway, is paralyized and sedated. Studies are showing it is causing more harm than good, and many programs are abandoning it. RSI is something the services I work for don't do, and while many medics have advocated for it, I don't see it happening here anytime soon. While securing an airway in a patient who needs one is the gold standard, sometimes the attempt to secure the airway can cause more damage than good. Prolonged hypoxia, misplaced tubes. I've heard horror stories of people breathing perfectly well, getting RSI, the crew not getting the tube, and the patient dying. That's doing harm. It only takes a few cases of harm to outweigh a saved life or two.

I was at my monthly medical advisory meeting and one service demonstrated a new intraosseous device they were considering using, which is like a power drill, it drills the IO right into the bone. See this link:

I went home and on an EMS discussion group I belong to, there was heated debate among doctors about the benefits of IOs at all, particuarly in trauma, where even IV fluids have been questioned. I've only done a few IOs in ten years -- all in kids in cardiac arrest. Some went in easy, one got bent and stuck in the bone. I've heard that services that are adopting the new adult IO devices are finding their medics like to play with the new devices and are "missing" their initial IV attempts to justify using the IO. We all like to play with our toys. I'm glad that some people are paying attention to research.

I will continue to post new research about EMS issues as I encounter it.