Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 What about starting IV/IO while transporting? Would that alleviate your concerns regarding transport times? The Bickell study does not define immediate fluid resuscitation, were the IV attempts done on scene or during transport? The Sampalis study states " on-site intravenous fluid replacement " . Do you know of any studies that looked at IV/IO attempts done while transporting vs on scene attempts? RE: Re: Adult IO Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Dear Dr. Bledsoe; You are not the first D.O. that has stated this to me it has even been stated crudely and rudely and then apologized for later by the leaned D.O. when he attending an emergency seminary and was thought other wise by M. D. . This seems to be a medical procedure that is thought in D. O. schools and my Medical Director an M.D. does not agree with you on fluids in the rural setting and in transport times that are in the 20 minute + range no offense is meant towards you this is not a science thing it is rural medicine verses metro medicine care and I hope you do not take offense to the lack of agreement with you sir. -------------------------------------------------------------------------------- RE: Re: Adult IO Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Dear Dr. Bledsoe; You are not the first D.O. that has stated this to me it has even been stated crudely and rudely and then apologized for later by the leaned D.O. when he attending an emergency seminary and was thought other wise by M. D. . This seems to be a medical procedure that is thought in D. O. schools and my Medical Director an M.D. does not agree with you on fluids in the rural setting and in transport times that are in the 20 minute + range no offense is meant towards you this is not a science thing it is rural medicine verses metro medicine care and I hope you do not take offense to the lack of agreement with you sir. -------------------------------------------------------------------------------- RE: Re: Adult IO Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Dear Dr. Bledsoe; You are not the first D.O. that has stated this to me it has even been stated crudely and rudely and then apologized for later by the leaned D.O. when he attending an emergency seminary and was thought other wise by M. D. . This seems to be a medical procedure that is thought in D. O. schools and my Medical Director an M.D. does not agree with you on fluids in the rural setting and in transport times that are in the 20 minute + range no offense is meant towards you this is not a science thing it is rural medicine verses metro medicine care and I hope you do not take offense to the lack of agreement with you sir. -------------------------------------------------------------------------------- RE: Re: Adult IO Obviously, you have not ben following the science. The prehospital administration of IV fluids is almost a thing of the past. There is minimal benefit and the time it takes to start an IV or IO increases the length of time to definitive care and disadvantageous. Thus, Mattox' point is there is no indication in any setting. BEB E. Bledsoe, DO, FACEP Midlothian, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 " Silsbee EMS " <silsbeeems@g...> wrote: > and was thought other wise by M. D. . This seems to be a medical > procedure that is thought in D. O. schools and my Medical Director > an M.D. does not agree with you on fluids in the rural setting > and in transport times that are in the 20 minute + range no Wow. How incredibly shallow. Do you not understand that Dr. Bledsoe's statements are taken directly from the research results, and that these researchers were medical doctors, and that they studied both rural and " metro " , as you put it? Can you not recognize when science trumps the " opinions " of MD and DO alike, and that there is no difference between the two? Are you so foolish as to believe medicine is taught differently in osteopathic schools than in medical schools? How very shallow indeed. The research demonstrates both you and your medical director need to pull your heads out of the sand, or where ever you keep yours. Larry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 " Silsbee EMS " <silsbeeems@g...> wrote: > and was thought other wise by M. D. . This seems to be a medical > procedure that is thought in D. O. schools and my Medical Director > an M.D. does not agree with you on fluids in the rural setting > and in transport times that are in the 20 minute + range no Wow. How incredibly shallow. Do you not understand that Dr. Bledsoe's statements are taken directly from the research results, and that these researchers were medical doctors, and that they studied both rural and " metro " , as you put it? Can you not recognize when science trumps the " opinions " of MD and DO alike, and that there is no difference between the two? Are you so foolish as to believe medicine is taught differently in osteopathic schools than in medical schools? How very shallow indeed. The research demonstrates both you and your medical director need to pull your heads out of the sand, or where ever you keep yours. Larry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 " Silsbee EMS " <silsbeeems@g...> wrote: > and was thought other wise by M. D. . This seems to be a medical > procedure that is thought in D. O. schools and my Medical Director > an M.D. does not agree with you on fluids in the rural setting > and in transport times that are in the 20 minute + range no Wow. How incredibly shallow. Do you not understand that Dr. Bledsoe's statements are taken directly from the research results, and that these researchers were medical doctors, and that they studied both rural and " metro " , as you put it? Can you not recognize when science trumps the " opinions " of MD and DO alike, and that there is no difference between the two? Are you so foolish as to believe medicine is taught differently in osteopathic schools than in medical schools? How very shallow indeed. The research demonstrates both you and your medical director need to pull your heads out of the sand, or where ever you keep yours. Larry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Sort of reminds me of an old saying. An old saying that has been said many times and in many ways. " Better to keep your mouth shut and look like an idiot, than open it and remove all doubt. " bkw RE: Re: Adult IO > > > > Obviously, you have not ben following the science. The prehospital > administration of IV fluids is almost a thing of the past. There is minimal > benefit and the time it takes to start an IV or IO increases the length of > time to definitive care and disadvantageous. Thus, Mattox' point is there is > no indication in any setting. > > BEB > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Sort of reminds me of an old saying. An old saying that has been said many times and in many ways. " Better to keep your mouth shut and look like an idiot, than open it and remove all doubt. " bkw RE: Re: Adult IO > > > > Obviously, you have not ben following the science. The prehospital > administration of IV fluids is almost a thing of the past. There is minimal > benefit and the time it takes to start an IV or IO increases the length of > time to definitive care and disadvantageous. Thus, Mattox' point is there is > no indication in any setting. > > BEB > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Sort of reminds me of an old saying. An old saying that has been said many times and in many ways. " Better to keep your mouth shut and look like an idiot, than open it and remove all doubt. " bkw RE: Re: Adult IO > > > > Obviously, you have not ben following the science. The prehospital > administration of IV fluids is almost a thing of the past. There is minimal > benefit and the time it takes to start an IV or IO increases the length of > time to definitive care and disadvantageous. Thus, Mattox' point is there is > no indication in any setting. > > BEB > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 Ahhh yes.....differences of opinion make the world go 'round. And if someone thinks different than you - or me - then good - makes life more interesting. >>> britton@... 4/19/2005 8:07:48 AM >>> Sort of reminds me of an old saying. An old saying that has been said many times and in many ways. " Better to keep your mouth shut and look like an idiot, than open it and remove all doubt. " bkw RE: Re: Adult IO > > > > Obviously, you have not ben following the science. The prehospital > administration of IV fluids is almost a thing of the past. There is minimal > benefit and the time it takes to start an IV or IO increases the length of > time to definitive care and disadvantageous. Thus, Mattox' point is there is > no indication in any setting. > > BEB > > > E. Bledsoe, DO, FACEP > Midlothian, TX > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 , You are really behind the times if you are making these comments. REALLY read the research! This is not a D.O. vs. M.D. opinion thing, nor is it a rural vs. urban thing. This is a what is best for the patient thing. I am not, nor have I ever been a huge fan of Dr. Mattox, but he does have a very convincing point when it comes to permissible hypotension. It (within reason) is protective, and the body can tollerate 70mmHg pressures for prolonged periods of time without significant problems. At 70mmHg, you are still perfusing. Granted, it challenges everything we were taught since the beginning of EMS, but you need to be open to change. BTLS & PHTLS both teach varying degrees of this. Part of the problem with dismissing Dr. Mattox is the fact that he literally wrote the book on Trauma! He is considered a leading authority, if not the leading authority in Trauma care in the U.S. Lets add that the research has proven not only higher mortality and morbidity following mass fluid administration in trauma patients, but it also increases the likelihood of renal failure, secondary ischemic events (due to decreased oxygen carrying capacity in the blood), etc. This is why the military has switched to using hypertonic 3% Saline in the field, and at most, they administer 250- 500ml of it. Remember, most of our information and training on trauma care, comes from the military. I personally was skeptical of this when it came out several years ago, however, I have seen better outcomes since we have started using this measure in the field. My cousin, who is a Trauma Surgeon in Abilene was totally opposed to the idea of permissible hypotension when it came out. After sitting down and talking about it for HOURS, I was able to convince him to at least give it a chance, and then form an opinion on it once he saw the outcomes for himself. He's a convert! He actually admits he was wrong, and insists that this is the only way to go now. By the way, I have always worked in primarily rural EMS settings with way greater than 20 minute transport times, and we have been employing permissible hypotension for 3-4 years now with GREAT outcomes. I think your MD needs to start reading up to date research and quit dismissing proven science as " hogwash " . It's this closed minded way of thinking that is holding back pre-hospital care. CB Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 The real question though is-Is it good science? One study, with a vague description (Penetrating Trauma to the Torso) is not good science. I should have been GSW to the URQ or Penetrating Stab wounds to the Spleen. Get accurate data on one type of injury and make a claim on that. Then do a study on another area and make a claim on that particular problem. But to come back and say there is no difference or little difference is bad science. How many of the patients would have died if the surgical team was sitting with the patient when in injury occurred. To many unanswered factors in the study. BH Re: Adult IO " Silsbee EMS " <silsbeeems@g...> wrote: > and was thought other wise by M. D. . This seems to be a medical > procedure that is thought in D. O. schools and my Medical Director an > M.D. does not agree with you on fluids in the rural setting and in > transport times that are in the 20 minute + range no Wow. How incredibly shallow. Do you not understand that Dr. Bledsoe's statements are taken directly from the research results, and that these researchers were medical doctors, and that they studied both rural and " metro " , as you put it? Can you not recognize when science trumps the " opinions " of MD and DO alike, and that there is no difference between the two? Are you so foolish as to believe medicine is taught differently in osteopathic schools than in medical schools? How very shallow indeed. The research demonstrates both you and your medical director need to pull your heads out of the sand, or where ever you keep yours. Larry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 19, 2005 Report Share Posted April 19, 2005 The real question though is-Is it good science? One study, with a vague description (Penetrating Trauma to the Torso) is not good science. I should have been GSW to the URQ or Penetrating Stab wounds to the Spleen. Get accurate data on one type of injury and make a claim on that. Then do a study on another area and make a claim on that particular problem. But to come back and say there is no difference or little difference is bad science. How many of the patients would have died if the surgical team was sitting with the patient when in injury occurred. To many unanswered factors in the study. BH Re: Adult IO " Silsbee EMS " <silsbeeems@g...> wrote: > and was thought other wise by M. D. . This seems to be a medical > procedure that is thought in D. O. schools and my Medical Director an > M.D. does not agree with you on fluids in the rural setting and in > transport times that are in the 20 minute + range no Wow. How incredibly shallow. Do you not understand that Dr. Bledsoe's statements are taken directly from the research results, and that these researchers were medical doctors, and that they studied both rural and " metro " , as you put it? Can you not recognize when science trumps the " opinions " of MD and DO alike, and that there is no difference between the two? Are you so foolish as to believe medicine is taught differently in osteopathic schools than in medical schools? How very shallow indeed. The research demonstrates both you and your medical director need to pull your heads out of the sand, or where ever you keep yours. Larry Quote Link to comment Share on other sites More sharing options...
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