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Mon Nov 7 16:43:59 GMT 2005

I hate spell-checkers: BEREAVED, not BELIEVED family.

I'm all about language.

Pret

-----Original Message-----
From: Bjorn, Pret [mailto:pbjorn at emh.org] 
Sent: Monday, November 07, 2005 9:06 AM
To: 'Trauma & Critical Care mailing list'
Subject: RE: ER Thoracotomy for Medical Arrest

This is a highly effective means of perpetuating a pointlessly energetic and
ignorant status quo.  Every case is a completely uncontrolled, unconsented
experiment conducted at the physical, emotional and financial costs of the
hapless patient, his believed family, the various payors, and our ethical
obligations.

With all this energy and interest, advocates should move beyond
irresponsible hypothesis and anecdote in favor of scientific method.  Maybe
there's a Nobel in it for you.  Until then, you're goofing off.

Pret

-----Original Message-----
From: Marcin & Ania [mailto:zawisza at lineone.net] 
Sent: Monday, November 07, 2005 8:47 AM
To: Trauma & Critical Care mailing list
Subject: Re: ER Thoracotomy for Medical Arrest

Oh I agree entirely. Just one thing - how are you going to prove it without 
doing it?
Another problem that todays medicine faces is the beliefe of some that all 
that can be done has been done and if someone is doing something different 
it must be wrong. It was that mentality which ment that for centuries 
abdominal surgery was considered to be equvalent to murder and when the 
first modern abdominal surgery was performed in 18th century there was a 
lynch mob standing outside with a noose around a branch. Fortunatelly the 
patient survived.
Without trying we just don't know.
30 years ago some guys from India advocated treating stomach ulcers with 
antibiotics. They gort laughed at- "No acid no ulcer" was the dictum at the 
time. This year a couple of guys got a Nobel prize for proving them right.
Personnaly I would not criticise anyone for doing something different if the

mortality is 100%, maybe they'll get it right this time. Sure you should do 
a trial,get ethical approval etc, but that is just medicolegal gobbledygoocs

designed to stop you getting sued. At the end of the day you end up doing 
the same thing to the patient.

Martin
----- Original Message ----- 
From: <docrickfry at aol.com>
To: <trauma-list at trauma.org>
Sent: Monday, November 07, 2005 12:09 AM
Subject: Re: ER Thoracotomy for Medical Arrest

> Here we go again turning the scientific method on its head--the absence of

> evidence favoring any intervention is pure and simply the strongest 
> contraindication for such--in the absence of supportive evidence of 
> benefit, it shouldd not be performed--to perfrom an UNPROVEN intervention 
> and then challenge all to prove it wrong is the greatest perversion of 
> science to achieve one's own agenda-- the greatest reason it is wrong is 
> it endangers the patient or health care provider for no proven benefit in 
> the face of known risks--thus violating the first principle of medicine--

> First do no harm!
> ERF
>
> -----Original Message-----
> From: Marcin & Ania <zawisza at lineone.net>
> To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> Sent: Sun, 6 Nov 2005 20:42:49 -0000
> Subject: Re: RE: ER Thoracotomy for Medical Arrest
>
>
> Just out of curiosity Pret did you find any evidence that it worsens the 
> outcome?
> "Lack of evidence is not the same as evidence of lack."
>
> Martin
> ----- Original Message ----- From: "p.bjorn" <p.bjorn at netzero.net>
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Saturday, November 05, 2005 8:01 AM
> Subject: Re: RE: ER Thoracotomy for Medical Arrest
>
>> Candie,
>>
>> You'll have to help me out on this one: I can't find much in the way of
>> supportive references for OC-CPR in the context of medical arrest. > 
>> There's
>> various research for trauma, and for post-op cardiac surgery patients; 
>> but
>> where's the data that recommends thoracotomy for the fellow who collapses

>>  > at
>> Burger King -- or the child who arrests from asphyxia? I can't imagine > 
>> that
>> this has ever been scientifically studied, much less proven worthwhile.
>>
>> I'd be obliged for references on-topic. And while you're there: what's an
>> ARNP, and what do you do at your trauma center?
>>
>> Pret
>>
>> ----- Original Message ----- 
>> From: <kokaramc at bellsouth.net>
>> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
>> Sent: Friday, November 04, 2005 6:18 PM
>> Subject: Re: RE: ER Thoracotomy for Medical Arrest
>>
>>
>>> Actually, there have been more than the one study you (Pret Bjorn, RN)
>> mentioned. Research some studies for the Journal of Trauma. I agree that
>> there are several variables (like comorbid issues) to be considered. But
>> knowing the profound limitations and seriously poor outcomes of CC-CPR, >

>> and
>> the fact that I am an ARNP in a level II trauma center and have actually
>> seen OC-CPR results, I would choose OC-CPR for my family. (Especially for

>>  > a
>> known downtime and after several minutes of unsuccessful CC-CPR)
>> Candie NP-C / Trauma
>>>
>>>
>>> > Date: 2005/11/04 Fri AM 10:24:17 EST
>>> > To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
>>> > Subject: RE: ER Thoracotomy for Medical Arrest
>>> >
>>> > -----Original Message----- 
>>> > From: Don Benson [mailto:bensonblues at comcast.net]
>>> > Sent: Tuesday, November 01, 2005 5:54 PM
>>> > To: trauma-list at trauma.org
>>> > Subject: ER Thoracotomy for Medical Arrest
>>> >
>>> > "I believe the more controversial subject is the role of thoracotomy 
>>> >  >> > and
>>> > open chest CPR in medical arrest."
>>> >
>>> >
>>> > Dr. Benson,
>>> >
>>> > The implication that rescuing five healthy dogs from lethal injection
>> should
>>> > in any way inform human resuscitation is beyond controversial. It's
>>> > miserably unsubstantiated wishful thinking.
>>> >
>>> > Instead of bolusing presumably healthy, well-oxygenated animals with
>> KCL,
>>> > try the same therapeutic strategy on dogs with profound CAD or >> > 
>>> > prolonged
>>> > respiratory arrest (the more common causes of asystole in adults and
>> kids,
>>> > respectively). Eager to be proven wrong, I nonetheless predict that
>> your
>>> > outcomes would, comparatively, suck.
>>> >
>>> > I have an eleven-year-old son, and I can't say with confidence what
>> choice
>>> > I'd make under the tragic circumstance you've described; but you'd
>> better
>>> > ask me before you go compounding my grief by mutilating his corpse on
>> zero
>>> > evidence that it will help anyone but you.
>>> >
>>> > I admire your passion, and empathize with your grief; but without a >>

>>> >  > much
>>> > better study, I reject what you're suggesting here.
>>> >
>>> > Pret Bjorn, RN
>>> > Aging, pudgy, indolent, stressed parent.
>>> >
>>> >
>>> > -- 
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>>> >
>>>
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>>>
>>
>>
>>
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> 

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