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Wed Mar 21 21:02:08 GMT 2007

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 &amp; 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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IO's?...good for?