Seeking Perspective from the Whiz Kids!

[firetender]

As for stuff not working, I wonder if some of the stuff we have used in the past (high dose Epi, multiple doses of bi-carb etc) does work, but only in very specific circumstances. Situations that are so specific that only a few people in a study qualify, meaning the medication statistically doesn't work.

Did that make sense?

This is a great observation that even I had forgotten about!

Allopathic medicine is defined as medical intervention that primarily depends on drugs and surgery.

Physically, as far as surgery goes, we ARE pretty much the same model.

Physiologically, however, we are composed of similar chemicals and cells that have attained a unique balance UNTO THEMSELVES. Each of us is different, and within each of us, the dis-ease process is unique.

Physiological influences include our perception of ourselves and the life around us. A negative mental image in place acts as a filter through which our body responds, literally creating the chemicals necessary to mirror our impressions. If we believe we are unhealthy, our body will manipulate our internal chemistry to reflect that, and every person's body may do it differently.

Early observation would include case studies "showing" how one particular intervention worked in a number of cases. Tracing backwards, physiological processes are identified and shown to be accurate in a test tube, and then intervention in the form of offering a new drug (usually with a specific effect accompanied by innumerable effects on other processes) adopted by the medical community. It very well could be reflecting only one particular segment of the population.

Quantum science is teaching us about frequency and how IT affects us. Right now much talk is going on about "designer drugs" which essentially "tune-in" to the individual's frequency and then provide a very specific "boost" to it to help it re-establish homeostasis.

The truth is, our dominant form of medical intervention is still in the stone age because we're still working with the concept that if all you got is a hammer, then everything is a nail.

 

[triemal04]

As for stuff not working, I wonder if some of the stuff we have used in the past (high dose Epi, multiple doses of bi-carb etc) does work, but only in very specific circumstances. Situations that are so specific that only a few people in a study qualify, meaning the medication statistically doesn't work.

Did that make sense?

You aren't babbling, in fact you're pretty much spot on. Firetender said something similar above (though much more eloquently); a lot of medicine assumes that everyone is the same, which can often be pretty much wrong. Veneficus said the same thing when talking about the H's and T's; those (and the rest of the pt's history) are what really matter and will, or should, play a large role in determining what med's the pt gets, but all to often people don't check for those, or can't check for them. A person who goes into cardiac arrest because of a MI shouldn't be treated the same as someone who goes into cardiac arrest because they haven't been dialyzed in 2 weeks; some treatments may be the same, but others are needed for one and not the other.

For some pt's bicarb IS the appropriate drug to give very early in the code; for other's it's not. Unfortunately, determining who it's right for is a bit difficult in the field, and even in the ER, though maybe less so. Hence why you get standard algorithms.

 

[ah2388]

In the spirit of where this thread is going...
I feel like ultimately there will be established protocols for various types of arrest. For example

For unwitnessed arrest without bystanders..there is a generic algorithm somewhat similar to the current guidelines.

For arrests associated with ______ cause, the algorithm differs. I definitely see there being pro's and cons to this but just the feeling I get as to where cardiac arrest protocols may be going

 

[Jon]

Firetender - I always appreciate your posts. They are always thought provoking and well reasoned. This one has actually caused even more thought than normal.

As a "Baby medic" I am always surprised by how much things have changed in the 30 years since Johnny and Roy started popping the caps off of the Bicarb amps.
On the same token... I am surprised by the way some things have gone back to the way they were... it used to be that medics used telemetry to send every EKG tracing to the ED... now we send every 12-lead to the ED.

I've been in the field for about 10 years, starting as a Fire Company Explorer and being an EMT for the last 8. I too have seen things change. I've seen PA state gone to statewide protocols. I've seen Lasix fall out of favor. I've seen Mast Pants go from "well... we have them on the trucks, but don't ever use them"... to... "What are MAST pants?". I've seen C-spine immobilization become a little less common... and I've seen refusals get to be much more paperwork.

I've seen the studies and explanations for the 2005 ACLS/BCLS changes... and I've seen the writing on the wall for some of the things we'll see next time... More compressions, less breathing, etc.

I too wonder what the future will hold. I am SURE that in another 30 years, the next crop of medics will look at what I'm doing and think that doing a 12-lead EKG isn't enough of a diagnostic tool... and that "every patient needs to go to the ED" was a pretty stupid idea... and they will have more tools to examine and assess the patient to attempt to determine how to treat them. And the vast majority of the folks I'm working with now will have moved on, with a few dinosaurs left to impart wisdom on the next generation.



And I think I'll have the same answer then that you do now, Firetender... we did it because it was the standard of care, and we didn't know any better.... that's why research is so important.