IO's?...good for?
Ronald Gross
Rgross at harthosp.org
Thu Mar 22 18:56:27 GMT 2007
And with a flame war we have gotten.....yet another smoke screen.
>>> <trauma at emergencyunit.com> 3/22/2007 2:29 PM >>>
Oh, dear. So rather than listen to the feller we'll patronise him. I have
stated that science is and if we are true scientists we should be too. I say
black is white - you care? You say black is white - equally, why should I
care? Propound and fail to disprove with an adequate experiment a theory
that black is white and we should all take notice. It doesn't matter whether
you or I do it - the theory should hold true until disproved. The world was
flat until disproved. The sun went round the earth until disproved - and
didn't authority dislike that researcher! Oh, sorry, anecdote again. But it
does help to make the point.
As I stated, I was not passing any comment on the quality of the papers save
to point out that they existed and appeared to originate from peer-reviewed
sources. The statement from Mattox was vague and did not pose any of us a
scientific question to answer: "I can find NO logical, ethical, clinical,
or traumatic indication for IO infusions of ANYTHING in ANY Patient at
ANYTIME." I found some.
Now had Mattox posed a real question, "Is there type 1 evidence that
intraosseous access is quicker than intravenous access?" or "Is there
increased mortality at 30 days if an intraosseous needle is sited?" we may
have been able to have a good and interesting discussion. As it is, all we
get is a flame war. Ho hum.
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: 22 March 2007 12:01
To: 'Trauma & Critical Care mailing list'
Subject: RE: IO's?...good for?
" Like Carl Sagan, I have no time for 'authority'. There are no authorities
in science, merely theories. Who articulates them is a matter of supreme
indifference to me."
Oh my, such contempt. My dear Blueflightmedic, you are starting to sound
like another frequent flyer on this list who shares your attitude and
contempt of authority. Be careful. You just might end up with the same
reputation and lack of credibility has that other doctor has attained.
I think you should read Dr. Smith's post again. His discussion of your
thought process and your extensive and in-depth investigation of the issue
at hand are in sharp contra-distinction to each other. Read carefully - you
just might find something to learn from an authority in the field.
Sorry, I forgot - you don't give a damn about authority.........
Best wishes,
Ron
>>> <trauma at emergencyunit.com> 3/21/2007 5:26 PM >>>
I was not passing any comment on their quality - I simply found three
through Google scholar that showed the technique existed and appeared to
have some value to those who wrote to peer-reviewed journals. Like Carl
Sagan, I have no time for 'authority'. There are no authorities in science,
merely theories. Who articulates them is a matter of supreme indifference to
me.
I can tell you that 'hanging iv' as you term it certainly can be life and
death, and your colleague has done the emergency community and their
patients no favours at all by misguidedly persuading all and sundry that
they should not give fluid. Only today I had to support two colleagues
talking to the grieving family of a man who died from multiple injuries in a
collision. He was talking when the paramedics arrived so everyone
concentrated on the other patient who was unconscious. Unseen and unnoticed
his multiple injuries bled, but a bit of hypotension never hurt. An hour and
a quarter later he suddenly crashed his blood pressure terminally. Only then
were frantic infusions started, and when he arrived at the ED he was in
irrecoverable cardiac arrest. From hypovolaemia. I trace that pretty
directly back.
Blueflightmedic.
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Robert F. Smith
Sent: 21 March 2007 21:02
To: 'Trauma & Critical Care mailing list'
Subject: RE: IO's?...good for?
Dear Blueflightmedic,
I am hesitant to appear to speak for Dr. Mattox, but I would draw your
attention to a couple of things. I guess you might call him a dinosaur in
the sense that Babe Ruth would be a dinosaur.
Regarding your references: 1) a review of the technique, contraindications,
indications etc. in which the authors claim without support of data that
this is a valuable approach in young Peds patients 2) a postal survey of EDs
in the UK where a 59% response rate showed that 7% of the responding EDs
used the technique and 3)where the authors propose to "assess the benefits
and drawbacks of intraosseous infusion (IOI) for emergency therapy in
children in a retrospective, non comparative study.
These references would seem to show that this technique can be done, most
people don't chose to use it in the UK, and the French authors don't seem to
understand the drawbacks and benefits of a retrospective non-comparative
"study" let alone those of IO. Being able to find a "reference" is not the
same as taking the time to read the actual article and being able to analyze
its value.
While Dr. Mattox offered a sweeping condemnation of this technique I'll make
the leap of faith that he was hopefully not talking about war zones and
probably not talking about non trauma Peds. While I've devoted my career to
avoiding non-trauma Peds, and realizing we're all more comfortable with
hanging fluid, how often is the need for IV access life and death? Are
drownings and cardiac arrests being resuscitated without ET tubes and the
subsequent access for most important drugs?
Dr. Mattox never said IO doesn't work. He expressed extreme reservation
about its NEED and EFFECT on OUTCOME for patients we typically discuss on
the TRAUMA LIST. You note that this technique was revived by war surgeons
which would be his exact point in drawing a parallel with the MAST suit. I
believe it would be fair to say he does not share many list members
enthusiasm for aggressive fluid resuscitation in trauma patients outside of
the OR setting.
R. Smith, MD
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of trauma at emergencyunit.com
Sent: Wednesday, March 21, 2007 3:59 PM
To: 'Trauma & Critical Care mailing list'
Subject: RE: IO's?...good for?
Boy, this list has some dinosaurs on it, doesn't it? There's none so blind
as those who can not see. If you haven't found any indication I have a
suggestion - start with looking for some references.
The technique has been in use for over 70 years and was resuscitated by war
surgeons for quick access to the vascular system. It is a very useful weapon
in the armamentarium for doctor, nurse and paramedic alike. As you are
clearly too lazy to find any information for yourself and can't imagine
anyone putting anything other than fluid through a vascular access start
with these:
http://www.nda.ox.ac.uk/wfsa/html/u12/u1210_01.htm
http://emj.bmj.com/cgi/content/abstract/17/1/29
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ui
ds=10228670&dopt=Citation
Blueflightmedic.
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: 20 March 2007 22:26
To: trauma-list at trauma.org
Subject: Re: IO's?...good for?
I have looked and looked. I can find NO logical, ethical, clinical, or
traumatic indication for IO infusions of ANYTHING in ANY Patient at
ANYTIME.
Unless one is attempting a cruel form of child abuse, or adult abuse.
Especially today when it is acknowledged that both for children, teen agers,
adults, etc., permissive hypotension and restrictive (to no) fluid
resuscitation is better than the old way, IO completely looses its market
and appeal.
I guess if you own stock in one of the companies that sell these instruments
of the devil, you might use them to try to increase your market return.
k
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