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

- Rogue Medic

It is better to NOT understand something true, than to understand something false – Example 1

Continuing with my explanation of the problems with wanting explanations for why something happens. Why something works. Why something doesn’t work.

The why is not the important part. What we need to know are –

What we can expect to happen.

Under what circumstances we can expect it to happen,

At what rate we can expect it to happen.

What complications we should watch for.


 

It is better to not understand something true, than to understand something false. – Neils Bohr.

 

For example, some people explain the effects of furosemide (Lasix) on acute CHF (Congestive Heart Failure) with some variation of the following –

 

Furosemide makes acute CHF better by moving fluid from the lungs to the bladder.

 

This is false.

 

If we believe (understand) the above false statement, that is dangerous for patients. We are likely to treat patients with furosemide, which has a nice story, but the story is false.

Even if we do not understand why CPAP (Continuous Positive Airway Pressure) and High-Dose NTG (NiTroGlycerin) are excellent treatments for acute CHF, we can still give them to patients and improve patient outcomes.

The side effects of furosemide may cause more harm than any benefit furosemide might provide in the emergency setting. Most of these patients are dehydrated and need to be given fluid in the ED (Emergency Department). Furosemide temporarily raises the blood pressure, but it is almost always more important to lower the blood pressure. Furosemide is for fluid overloaded patients, but acute CHF patients are usually not fluid overloaded – the fluid is just in the wrong place.

Furosemide does not transfer fluid from the lungs to the bladder.

Why?

It is not important to know why this magic does not happen. We only need to know that it does not happen.

Does removing excess fluid from the body help stable CHF?

If the CHF is due to fluid overload, then furosemide probably does help stable patients. We are not really interested in what works when the patient is stable. We are interested in what works when that patient is no longer stable – the emergency patient.

If we dehydrate the body even more, then that may pull some fluid out of the lungs, but that is not making things better.

The patient is hypertensive and dehydrated with wet lungs.

We want to fix all 3 of the problems. Our goal is not to make one of the problems worse and hope that miraculously fixes the other 2 problems.

See also EMS NTG for CHF – Bolus or Infusion – Part II.

Added 02/05/2012 @ 14:00 – An example pertinent to today – Super Bull Sunday on the manufactured explanation for a non-existent rise in domestic violence on the day of the Super Bowl from snopes.com.

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