List Archives

Wed Mar 21 21:26:25 GMT 2007

Great response Dr. Smith! I find it interesting that blueflightmedic
accuses Dr. Mattox of being a dinosaur, too blind to see and lazy, when
he himself certainly seems too blind and lazy to read the "studies" that
he quotes, and fails to see Dr. Mattox' point that with the evidence
based studies regarding permissive hypotension that IO's are not often
required. How many of us in the states routinely work on a patient who
has been struck by a roadside bomb or RPG? This may very well be an
indication for IO to the "war surgeons", but again we aren't treating
war injuries here. My guess is that blueflightmeic, is one of those who
arrives on scene unzips his flight suit and bears his big red "S" and
tells everyone to step back as he has arrived to save the day. 
Rick Moore, RN,LP

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith
Sent: Wednesday, March 21, 2007 4:02 PM
To: 'Trauma &amp; 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 &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&lis
t_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

************************************** AOL now offers free email to
everyone. 
 Find out more about what's free from AOL at http://www.aol.com.
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

IO's?...good for?