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

- Rogue Medic

AEDs and Water

In an earlier post, Off Duty CPR in the Middle of the Road, I wrote about the perceived problem of moisture on the ground when shocking a patient. I do not recall what led me to post that now, but I have found some research on the topic. None of these studies found any problems with defibrillating wet patients. They found that the current delivered to the patient was adequate for defibrillation and that it was safe for rescuers to defibrillate the wet patient. Some of these were addressing the conditions that would affect defibrillation of a patient during therapeutic hypothermia with ice water and with saline. The one bit of advice was to dry the chest before applying pads, but that should be obvious. 🙂

Click on each study for it’s abstract. The one without an abstract is an editorial about the study below it.

Klock-Frézot JC, Ohley WJ, Schock RB, Cote M, Schofield L.
Successful defibrillation in water: a preliminary study.
Conf Proc IEEE Eng Med Biol Soc. 2006;1:4028-30.
PMID: 17945819 [PubMed – indexed for MEDLINE]

Only a small difference was measured in the overall defibrillation voltage and current as applied to the electrodes for the different cases. Thus, underwater defibrillation is safe and can be performed effectively.

de Vries W, Bierens JJ, Maas MW.
Moderate sea states do not influence the application of an AED in rigid inflatable boats.
Resuscitation. 2006 Aug;70(2):247-53. Epub 2006 Jun 27.
PMID: 16806638 [PubMed – indexed for MEDLINE]

Our study demonstrated that all the AEDs involved are robust enough to be used on RIBs (Rigid Inflatable Boats); none of them gave problems with monitoring or defibrillation,

Lyster T, Jorgenson D, Morgan C.
The safe use of automated external defibrillators in a wet environment.
Prehosp Emerg Care. 2003 Jul-Sep;7(3):307-11.
PMID: 12879378 [PubMed – indexed for MEDLINE]

CONCLUSIONS: Thirty volts may result in some minor sensation by the operator or bystander, but is considered unlikely to be hazardous under these circumstances. The maximum currents were lower than allowed by safety standards. Although defibrillation in a wet environment is not recommended practice, our simulation of a patient and a rescuer/bystander in a wet environment did not show significant risk should circumstances demand it.

Varon J.
Therapeutic hypothermia and the need for defibrillation: wet or dry?
Am J Emerg Med. 2007 May;25(4):479-80. No abstract available.
PMID: 17499671 [PubMed – indexed for MEDLINE]

Comments positively on the study below, from the same publication.

Schratter A, Weihs W, Holzer M, Janata A, Behringer W, Losert UM, Ohley WJ, Schock RB, Sterz F.
External cardiac defibrillation during wet-surface cooling in pigs.
Am J Emerg Med. 2007 May;25(4):420-4.
PMID: 17499660 [PubMed – indexed for MEDLINE]

Transthoracic defibrillation via AED pads is safe and effective in a wet condition after cooling with ice-cold water in a pig VF cardiac arrest model because ROSC could be achieved in all animals. Thus, this new cooling device needs further exploration in cases of cardiac arrest
in humans.

Calling Dr. Deborah Peel – Anyone Home?

 

While looking at Notes from Dr. RW, a good medical site, I found a post (Psychoanalyzing medical bloggers on NPR’s Morning Edition – from March 17, I could not find a direct link, but it is in his archives). I posted the following comment on his site. Dr. Peel had commented on the same post, so I thought she might read it and respond. No luck, yet.

Being a diligent gadfly, I decided to post to Dr. Peel’s blog directly. The problem is that she has not posted anything since February. Apparently, she has more important fish to fry than medical bloggers. So, I posted the same comment after an excellent comment by erdoc85 (from M.D.O.D.) about her on air foolishness on a post from October that is more relevant than her post from February.

Her fan must go crazy waiting for his next exciting Peel Post.

If you search “Deborah Peel” blog the first two results are for White Coat Rants (read his posts) and her blog is all the way down at result number five. Sweet.

She is paving the road to hell (for patients and health care providers) with her oh-so-good intentions.

Let me know what you think of this comment, not enough oomph?
 

Dr. Peel jumps to the conclusion that the patients being described are individuals and not composites, that they are easy to identify and that the information about the patients has not been changed to make identification essentially impossible.

I dare Dr. Peel to identify any patient from my site. I have been using the pseudonym “Deborah Peel” for all of my patients and for some of my coworkers since her appearance on NPR.

How does a physician mass diagnose people without ever meeting them?

How does a physician prescribe treatment to people based on that fraudulent diagnosis?

Medical professionalism is completely absent from her behavior, yet she accuses others of being unprofessional and inappropriate.

Where does she find any evidence that blogs are any more of a threat to patient privacy than medical books?

House of God, MASH, Awakenings, …

There are many books that have been written on medical topics that do not always put the patient in the best light. Where is her outrage?

Where is the concern for the privacy of these patients?

Perhaps she does not read books and is unaware of the phenomenon of bound volumes of printed pages compiled for entertainment or even education.

What about television? ER has all sorts of information about patients and – horrors – you can see the patients (maybe she does not know they are only actors).

Imagine if any of those patients were to watch the TV show and recognize their own medical case being portrayed on screen.

If you want less than positive portrayals of patients and staff, what about House, MD?

She probably does not understand the sarcasm.

Dr. Deborah Peel should be reported to the state medical board for her on air medical malpractice. She should also be continuously ridiculed for her blatant hypocrisy.

Or, maybe I am wrong and she is the answer to all of the world’s problems.

 

CNN is Selling Snake Oil – All You Have to Do is Believe.

CNN has recently run two stories that seem to have nothing to do with journalism. Rather, they mock journalism.

Brain-dead baby recovers trumpets the news that a baby who was brain-dead really recovered. In the story, not that anyone reads details any more, they only mention that the baby was pulseless. Nowhere in the story is there any mention that he was brain dead.

Should CNN change the misleading and unethical title?

No, this brings viewers and CNN can do anything to make more money.

In the more recent story, Man declared dead, says he feels ‘pretty good, in the article CNN claims that the man was brain-dead, but no medical staff are quoted. No mention of attempting to obtain comments from the doctor in charge of this man’s care.

His father, Doug, said he saw the results of the brain scan.

“There was no activity at all, no blood flow at all.”

Maybe I am a cynic, but I’m guessing that this is the first “brain scan” that he has claimed to have seen. We might want a second opinion, maybe from someone trained to interpret them.

Not if you are CNN or Associated Press – the attributed source of the story.

What happened to at least two sources?

What happened to common sense?

What happened to medicine?

It seems that CNN has become jealous of the ratings of reality TV shows and want to join in.

Well, reality TV is as much about reality as homeopathy is about patient care.

Maybe I will vary my patient pseudonym between CNN and Dr. Deborah Peel – two peas in a pod.