Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

On the relative wisdom of synchronized cardioversion without sedation – Part I


Over at Prehospital 12 Lead ECG, Tom Bouthillet writes On the relative wisdom of synchronized cardioversion without sedation.

Rogue Medic and I don’t always agree, but we agree more than we disagree.

I agree. 🙂

When we disagree, it’s usually because I think RM is being deliberately controversial. He is the Rogue Medic, after all.

Maybe I am just looking at things from a different perspective.

Let’s look at how the Princeton University WordNet defines “rogue“.

Noun

(n) rogue, knave, rascal, rapscallion, scalawag, scallywag, varlet (a deceitful and unreliable scoundrel)

A deceitful and unreliable scoundrel.

Now that’s just funny and I don’t care who you are!

Varlet Medic just didn’t have the same ring to it, but scalawag and rapscallion have flair panache. Not as much panache as Rogue.

As long as you don’t call me an Upstart!

[youtube]_gDtu5fx62o[/youtube]

So now we come to Rogue Medic’s recent post Cardioversion – 2010 ACLS – Part III.

Why are we skipping over Part I and Part II?

Before we go further (or is it farther?) it needs to be said that you shouldn’t start what you can’t finish. I’m filled with those awful presentiments that a commander must feel when he orders the first shots fired in an action that will certainly provoke an immediate and disproportionate response.

Further.

Immediate and Disproportionate Medic was also a possible name for my blog. 😉

If you can’t tell, Tim Noonan and I are friends, although we’ve never met in “real life”. Somehow I missed him at EMS Today which was disappointing.

Ditto.

Tom is one person who actually seems to get my sense of humor.

In this post, Rogue Medic amends his statement from Part II to read:

In what way is the electrocution cardioversion or defibrillation of an awake patient not a sentinel event that requires the medical director to justify the abuse of this patient to the state medical board?

The drama!

Not drama! – perspective.

Drama Medic was not a consideration for blog title. 🙁

Please explain why cardioversion or defibrillation of an awake patient should not be considered a sentinel event.

Here’s the problem I have with what Rogue Medic is saying (beyond the fact that it’s inflammatory).

A conscious but hemodynamically unstable patient in non-sinus tachycardia (where the signs and symptoms are thought to be caused by the tachycardia) is in a precarious position and it’s not given to us to know ahead of time whether or not synchonized cardioversion is going to work.

Inflammatory? I am just adding perspective.

True. We never know if any treatment we use is going to work. Ever.

Precarious? Yes, but how precarious?

And will severe pain make things less precarious?

After the fact, we may speculate endlessly about what happened and why it happened and how everything would have been different if only . . . , but we rarely know.

On the other hand, I have no doubt that the synchronized cardioversion of an awake and alert patient is going to hurt.

By hurt I mean hurt the patient, not hurt me, unless I inadvertently shock myself, while shocking the patient.

Furthermore, by hurt, I do mean immediate and disproportionate pain.

To be continued in On the relative wisdom of synchronized cardioversion without sedation – Part II and later to be continued in On the relative wisdom of synchronized cardioversion without sedation – Part III and even later continued in On the relative wisdom of synchronized cardioversion without sedation – Part IV.

.

Trackbacks

  1. […] This post was mentioned on Twitter by EMS Blogs, Chronicles of EMS. Chronicles of EMS said: On the relative wisdom of synchronized cardioversion without sedation – Part I http://bit.ly/cRVCQI Via @EMSblogs #CoEMS […]

  2. […] from On the relative wisdom of synchronized cardioversion without sedation – Part I, which began my response to Tom Bouthillet, at Prehospital 12 Lead ECG, writing On the relative […]

  3. […] Synchronized Cardioversion Without Sedation – Part II, Tom Bouthillet responds to my posts Part I and Part II (I haven’t even posted Part III or Part IV, yet), responding to his earlier post […]

  4. […] from On the relative wisdom of synchronized cardioversion without sedation – Part I, then followed by On the relative wisdom of synchronized cardioversion without sedation – Part […]

  5. […] from On the relative wisdom of synchronized cardioversion without sedation – Part I, then followed by On the relative wisdom of synchronized cardioversion without sedation – Part […]

Speak Your Mind