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Thu Mar 22 18:08:52 GMT 2007

I have the autopsy report for that, thanks. As is well known, the delay to
definitive care is not associated with an adverse outcome (e.g. Ann Emerg
Med. 1991 Aug;20(8):882-6.) but delay to any treatment may be.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of walkersteve at bigpond.com
Sent: 21 March 2007 23:21
To: Trauma &amp, Critical Care mailing list
Subject: RE: IO's?...good for?

Its difficult to be definitive until you actually know the cause of death.
For all you know, this guy could have had an MI!

Anyway, it would appear that criticism of the care of this unfortunate 2nd
patient should surely be directed more at the issue of prolonged (75
minutes!!!!!) medical abandonment rather than whether or not IV fluids were
used.

Steve Walker
Emergency Physician
Nepean Hospital
Sydney Australia 

---- trauma at emergencyunit.com wrote: 
> I was not passing any comment on their quality - I simply found three 
> through Google scholar that showed the technique existed and appeared 
> to have some value to those who wrote to peer-reviewed journals. Like 
> Carl Sagan, I have no time for 'authority'. There are no authorities 
> in science, merely theories. Who articulates them is a matter of 
> supreme indifference to me.
> 
> I can tell you that 'hanging iv' as you term it certainly can be life 
> and death, and your colleague has done the emergency community and 
> their patients no favours at all by misguidedly persuading all and 
> sundry that they should not give fluid. Only today I had to support 
> two colleagues talking to the grieving family of a man who died from 
> multiple injuries in a collision. He was talking when the paramedics 
> arrived so everyone concentrated on the other patient who was 
> unconscious. Unseen and unnoticed his multiple injuries bled, but a 
> bit of hypotension never hurt. An hour and a quarter later he suddenly 
> crashed his blood pressure terminally. Only then were frantic 
> infusions started, and when he arrived at the ED he was in 
> irrecoverable cardiac arrest. From hypovolaemia. I trace that pretty 
> directly back.
> 
> Blueflightmedic.
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Robert F. Smith
> Sent: 21 March 2007 21:02
> 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&l
> ist_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?