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Fri, 11 Apr 2003 09:01:13 -0400

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-----Original Message-----
From: caesar ursic [  <mailto:cmursic@yahoo.com> mailto:cmursic@yahoo.com]
Sent: Thursday, April 10, 2003 10:08 PM
To: trauma-list@trauma.org
Subject: RE: Opiates & the Acute Abdomen

"...The point is that there is no good data that proves that premedicating
these patients does not affect the surgeons ability to render an accurate
diagnosis...."

Dr. Ursic,

With all respect, I'd caution against using the Nissman paper as a central
script for your position.  It's provocative, but undeniably flimsy: this is
basically a 5-question phone survey of 60 EM physicians (about an hour's
worth of investigation--two, if you include the math and don't allow for a
calculator), contrasted against a critique of four presumably selected
studies (none of which was less than 6 years out) and four anecdotes of
variable pertinence.  There's precious little science here.

Furthermore, about two-thirds of the reference list is more than 10 years
old (and more than half of these articles go back 20+ years).  In less than
two minutes, I found a dozen pertinent references on PubMed which were less
than five years old, and which are generally supportive of early analgesia.
Given all of this, Dr. Nissen and his colleagues would have had a tough time
getting this effort past my baccalaureate nursing faculty.  This isn't
research; it's a coarsely-informed editorial.

If anything, the paper rationally suggests that narcotic analgesia be
administered judiciously, and that EM clinicians seek and respect the advice
of their surgical colleagues in developing a consistent and cooperative
approach to prompt and effective management of these patients.  No argument
from me there.  

Pret Bjorn
Trauma Coordinator
EMMC Trauma Program
489 State Street
Bangor, ME 04401

207.973.7260 (office)
207.973.7673 (fax)
207.941.5085 (voice pager)

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<DIV><FONT face=Arial size=2>-----Original Message-----<BR>From: caesar ursic 
[</FONT><A href="mailto:cmursic@yahoo.com"><FONT color=#000000 face=Arial 
size=2>mailto:cmursic@yahoo.com</FONT></A><FONT face=Arial size=2>]<BR>Sent: 
Thursday, April 10, 2003 10:08 PM<BR>To: trauma-list@trauma.org<BR>Subject: RE: 
Opiates &amp; the Acute Abdomen<BR><BR>"...The point is that there is no good 
data that proves that premedicating these patients does not affect the surgeons 
ability to render an accurate diagnosis...."<BR></FONT></DIV>
<DIV><FONT face=Arial size=2>&nbsp;</DIV></FONT>
<DIV><FONT face=Arial size=2><FONT color=#800000></FONT></FONT><FONT face=Arial 
size=2><FONT color=#800000>Dr. Ursic,</FONT></FONT></DIV>
<DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV>
<DIV><FONT face=Arial size=2><FONT color=#800000>With all respect, I'd caution 
against using the Nissman paper as a central script for your position.&nbsp; 
It's provocative, but undeniably flimsy: this is basically a 5-question phone 
survey of 60 EM physicians (about an hour's worth of investigation--two, if you 
include the math and don't allow for a calculator), contrasted against a 
critique of four presumably selected studies (none of which was less than 6 
years out) and four anecdotes of variable pertinence.&nbsp; There's precious 
little science here.</FONT></FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2>Furthermore, about two-thirds of the 
reference list is more than 10 years old (and more than half of these articles 
go back 20+ years).&nbsp; In less than two minutes, I found a dozen pertinent 
references on PubMed which were less than five years old, and which are 
generally supportive of early analgesia.&nbsp; Given all of this, Dr. Nissen and 
his colleagues would have had a tough time getting this effort past my 
baccalaureate nursing faculty.&nbsp; This isn't research; it's a 
coarsely-informed editorial.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2>If anything, the paper rationally 
suggests that narcotic analgesia be administered judiciously, and that EM 
clinicians seek and respect the advice of their surgical colleagues in 
developing a consistent and cooperative approach to prompt and effective 
management of these patients.&nbsp; No argument from me there.&nbsp; 
</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV>
<DIV><FONT color=#800000 face=Arial size=2>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>Pret 
Bjorn</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>Trauma 
Coordinator</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>EMMC 
Trauma Program</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>489 
State Street</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>Bangor, ME 04401</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>207.973.7260 (office)</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>207.973.7673 (fax)</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>207.941.5085 (voice 
pager)</SPAN></FONT></DIV></FONT></DIV></DIV></BODY></HTML>

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