ERDoc Posted June 9, 2006 Author Share Posted June 9, 2006 Touche'...I am in the process of doing this and I regularly try to make a habit of searching on my own first. I was asking to see if you knew of any recent ones off the top of your head is all...since you mentioned you do the 'journal club thing' most probably for a residency program, I figured you may have something in mind. ACE There are a few in the past 4-5 years, but I can't think of them off of the top of my head. Anesthesia is always trying to prove that airway management is not something ER docs should be doing, so they love to try to prove it (and usually fail). 8) Link to comment Share on other sites More sharing options...
akroeze Posted June 9, 2006 Share Posted June 9, 2006 touche Actually, it's touché Link to comment Share on other sites More sharing options...
ERDoc Posted June 9, 2006 Author Share Posted June 9, 2006 So, trying to keep the original purpose of posting this thread, I added a little poll. Please take a moment to vote. Remember, the doctor is always right. 8) Link to comment Share on other sites More sharing options...
Punisher Posted June 9, 2006 Share Posted June 9, 2006 Remember, the doctor is always right. 8) Give me two more years of undergrad, four years of med school and three years of residency and this will be my signature on here. Link to comment Share on other sites More sharing options...
Asysin2leads Posted June 9, 2006 Share Posted June 9, 2006 So....you acknowledge that studies exist suggesting ALS airway management lowers patient survival outcomes, but you blame the theory on ALS makes matters worse on EMT's who are hellbent on jusdtifying lower levels of training? Just playing devils advocate here, but it sounds like your blame is going in a poor direction... ALS efficency - Literature review ALS airway review Heres a bit of research to start....concentrate on the latter study, good read and a rather reliable source... Wow, someone's pretty full of themselves, huh? Boy I'm glad I read the forum today, got some neato keen places to start my edu-ma-cation into them fancy journalies things. But, since it seems you may have been a bit confused by my first post, I'll try again, using some smaller words for you. I said I wouldn't doubt that studies exist showing patients who have had ALS airway maneuvers attempted on them have a lower survivability rate. This doesn't necessarily mean, however, that advanced airway maintenence in the field is not overall beneficial to patients needing it. There is a saying that is familar to anyone who has taken probability and statistics, and that is "correlation is not causation." Say that a few more times, tell me what you think it means in terms survivability rates and prehospital airway management. As for my crack about the frustrated EMT's, I meant that when a study comes out like this, it warrants further investigation. However, to the aforementioned EMT's, it gets to be field day into justifying their lower level of training, and if you'd like me to find a study on that, I'd love too. Also, as side note, its my belief that arrogance in medicine over all kills more people annually than all the missed tubes combined. Know what I mean? Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 9, 2006 Share Posted June 9, 2006 Wow, someone's pretty full of themselves, huh? Boy I'm glad I read the forum today, got some neato keen places to start my edu-ma-cation into them fancy journalies things. But, since it seems you may have been a bit confused by my first post, I'll try again, using some smaller words for you. I said I wouldn't doubt that studies exist showing patients who have had ALS airway maneuvers attempted on them have a lower survivability rate. This doesn't necessarily mean, however, that advanced airway maintenence in the field is not overall beneficial to patients needing it. There is a saying that is familar to anyone who has taken probability and statistics, and that is "correlation is not causation." Say that a few more times, tell me what you think it means in terms survivability rates and prehospital airway management. As for my crack about the frustrated EMT's, I meant that when a study comes out like this, it warrants further investigation. However, to the aforementioned EMT's, it gets to be field day into justifying their lower level of training, and if you'd like me to find a study on that, I'd love too. Also, as side note, its my belief that arrogance in medicine over all kills more people annually than all the missed tubes combined. Know what I mean? Full of myself? Not in the least bit. Not today at least....maybe tomorrow and definately yesterday, but today? Notsomuch. I actually agreed with you, just was playing devils advocate, as outlined in posts between the original and the first, where I not only agreed with you, and made further points regarding the correlation between the haste of the medical community to remove skills from ALS skilsets when a few studies are presented that suggest medics are having difficulty with specific skills. Regarding the need for ALS airway management, I dont really have an opinion. There are too many studies for and against it to really give me a true opinion. Yep, thats in a post above too. Asys, doesnt seem like im the one with a reading comprehension issue, seems you didnt take the time to read the posts after the initial ones. Insult my intelligence again, i'd suggest you read everything I wrote completely. Link to comment Share on other sites More sharing options...
Asysin2leads Posted June 9, 2006 Share Posted June 9, 2006 I did read everything you wrote. I'm testy on the whole airway management issue because I work in a system that loves to tie the hands of medics trying to do their jobs. Because of the 'dubious benefit of ALS airway management', and the 'No ALS for trauma' mythos it breeds, the largest EMS system in the country, mine, believes that a call for a seizing head injury patient should be a BLS call only, because the transport times are so short. Well, that and the administration is a bunch of nincompoops, but we really can't help that. I've read the studies and I've seen the statistics, and I agree that the rate of esophageal intubation ending up at the hospital is far from acceptable. That, quite frankly, is the most disturbing aspect of these airway management reports, not that tubes are missed (it happen), but that misplacement is not noticed before arrival at the hospital. That being said, it is not a reason to further increase the brain damage rates in trauma care by hamstringing the medics who know the difference between bilateral lung sounds and a distended abdomen. I also have read the reports calling into question the benefits of antiarhythmics in cardiac arrest survival. If you've gone into arrest in the field, 90% of the time, either a miracle will happen and you'll get a ROSC within the first 5 minutes, or the person is plant food. This doesn't mean, however, that we should turn in our IVs, drugs, and big heavy monitors for AED's and faster trucks. What I'm saying is there is more to analysis of the benefits of field procedures then statistical trends. Link to comment Share on other sites More sharing options...
Punisher Posted June 9, 2006 Share Posted June 9, 2006 Also, as side note, its my belief that arrogance in medicine over all kills more people annually than all the missed tubes combined I think arrogance plays a major role in many of those missed tubes to be quite honest. Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 9, 2006 Share Posted June 9, 2006 I did read everything you wrote. I'm testy on the whole airway management issue because I work in a system that loves to tie the hands of medics trying to do their jobs. Because of the 'dubious benefit of ALS airway management', and the 'No ALS for trauma' mythos it breeds, the largest EMS system in the country, mine, believes that a call for a seizing head injury patient should be a BLS call only, because the transport times are so short. Well, that and the administration is a bunch of nincompoops, but we really can't help that. I've read the studies and I've seen the statistics, and I agree that the rate of esophageal intubation ending up at the hospital is far from acceptable. That, quite frankly, is the most disturbing aspect of these airway management reports, not that tubes are missed (it happen), but that misplacement is not noticed before arrival at the hospital. That being said, it is not a reason to further increase the brain damage rates in trauma care by hamstringing the medics who know the difference between bilateral lung sounds and a distended abdomen. I also have read the reports calling into question the benefits of antiarhythmics in cardiac arrest survival. If you've gone into arrest in the field, 90% of the time, either a miracle will happen and you'll get a ROSC within the first 5 minutes, or the person is plant food. This doesn't mean, however, that we should turn in our IVs, drugs, and big heavy monitors for AED's and faster trucks. What I'm saying is there is more to analysis of the benefits of field procedures then statistical trends. Then we agree then. If everything came down to statistical trends, we'd be in herses with first aid cars. Like every other problem, it goes back to education it seems... Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 9, 2006 Share Posted June 9, 2006 I think arrogance plays a major role in many of those missed tubes to be quite honest. If you've heard "dude I know im in" as you watch a belly inflate with no sounds once, you've heard it a thousand times. Well put. Link to comment Share on other sites More sharing options...
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