Sylvia Browne is receiving some deservedly bad press for the exposure of her psychic deception.
 

In 2004, the year following the then 16-year-old schoolgirl’s disappearance, Browne appeared on “The Montel Williams” show and told Berry’s distraught mother Louwana Miller – who died from heart failure a year later – that her daughter was “in heaven and on the other side” and that her last words were “goodbye, mom, I love you.”^[1]

Should anyone be surprised?

But where’s the harm?

Psychics make their living by exploiting our selective memories.

We remember the hits, but forget the misses.

If I throw out as many guesses as I can, some of them are bound to be right.

Should I tell you I have the ability to see the future, or communicate with the dead?

This is not a psychic power.

This is deceit.
 

Jeffrey Skilling is trying to get a sentence reduction for his part in the disaster that was Enron. Fraud? Mismanagement? The Secret?

He spoke haltingly, stopping in mid-sentence. “In terms of remorse, Your Honor, I can’t imagine more remorse,” he said. He had “friends who have died, good men.” He was innocent—”innocent of every one of these charges.” He spoke for two or three minutes and sat down.^[2]

Malcolm Gladwell provides a good argument that what Jeffrey Skilling did was not an intentional fraud. It was complicated. It was not hidden. Maybe Skilling was a more of a true believer than a fraud.

He apparently believed that the problem was that the employees were not willing to do what was necessary to make the company grow at an unsustainable pace. He should be able to demand results and it is their fault if they cannot deliver. Why let reality get in the way of a perfectly good plan?

The Enron financial statements were examined two years before the peak using the information that was available at the time.
 

The students’ conclusions were straightforward. Enron was pursuing a far riskier strategy than its competitors. There were clear signs that “Enron may be manipulating its earnings.” The stock was then at forty-eight —at its peak, two years later, it was almost double that—but the students found it over-valued. The report was posted on the Web site of the Cornell University business school, where it has been, ever since, for anyone who cared to read twenty-three pages of analysis. The students’ recommendation was on the first page, in boldfaced type: “Sell.”^[2]

We don’t want to know the truth. If you had shorted Enron at the time, you probably would have lost a lot of money and had to cover your losses before Enron dropped to its actual value – less than nothing. Enron’s debts were much greater than its assets.

Psychics depend on this gullibility, too.

This is beyond your understanding.

It is arrogant to question what I am doing.

John Edward also scam the bereived and he had the backing of America’s favorite scam promoter – Dr. Mehmet Oz.
 

In a letter to producers of “The Dr. Oz” show Nordal said, “I provided very balanced responses to Dr. Oz’s questions during the show’s taping, however, the editing of my responses did not capture my full comments or give viewers an accurate portrayal of my professional view on John Edward’s methods. Instead, it seems that ‘The Doctor Oz’ show intentionally edited my responses in a way that gave the appearance of my endorsement of Edward’s methods as a legitimate intervention.”^[3]

Dr. Oz is as bad as John Edward and Sylvia Browne. He is promoting stuff that a child should realize is nonsense.^[4]

People trust him, even though he promotes frauds.

How is Sylvia Browne any better than Jeffrey Skilling?

How is John Edward any better than Jeffrey Skilling?

How is Dr. Mehmet Oz any better than Jeffrey Skilling?
 

The Pigasus Award for Refusal to Face Reality goes to Dr. Mehmet Oz, the Harvard-trained cardiologist who hosts The Dr. Oz Show on broadcast television, one of the most popular syndicated television shows in America. The only person to have won a Pigasus Award two years in a row, he wins a third time this year for his continued promotion of quack medical practices, paranormal belief and pseudoscience, including pseudoscientific Reparative Therapy to “cure” gay people, the “energy-healing practice” of Reiki as a way to cure disease, various TV psychics and mediums such as Theresa Caputo and John Edward, faith healers such as “John of God,” GMO conspiracy theories, and any number of new quack diets, herbal remedies, anti-aging cures, and untested “wonder drugs,” among many other pseudoscientific and paranormal claims.^[5]

Harry Houdini is reported to have stated –

It is not for us to prove the mediums are dishonest, it is for them to prove that they are honest.

Houdini spent years exposing the fraudulent methods of the psychics of his day.

We still believe in magic.

The reason we seem to treat this fraud as something other than fraud is that we act like we know what is best for the people we know who are gullible.

We assist in the fraud.

We lie to people to make us feel that we are helping their grief.

-

Footnotes:

-

^[1] Celebrity psychic Sylvia Browne hit for telling mom of Amanda Berry she was dead
By Hollie McKay
Published May 09, 2013
FoxNews.com
Article

-

^[2] Open Secrets Enron, intelligence, and the perils of too much information.
The New Yorker
January 8, 2007
Malcolm Gladwell
Article

-

^[3] TV Skeptic: The medium and Oz
March 18, 2011 | 2:05 pm
LA Times
Article

-

^[4] The trouble with Dr. Oz
David Gorski
Science-Based Medicine
April 26, 2011
Article

-

^[5] JREF’s Pigasus Awards “Honors” Dubious Peddlers of “Woo” (VIDEO)
Latest JREF News
James Randi Educational Foundation
Article with video

.

In spite of the evidence to the contrary and a lack of rationality in the claim, we continue to be told that increasing the number of people with a title, such as paramedic, will result in better care.

Here is more evidence that dividing the skills among more people leads to less skilled care.

The authors begin by referring to other studies that demonstrate the high failure rate of doctors performing procedures on children.

How is that relevant to EMS? We have a low frequency of use of critical skills – and that is with our adult patients. With children, our absence of experience is even more of a problem. When we do use our infrequently used skills, we often use them inappropriately.^[1],^[2]
 

Emergency physicians must be competent in the performance of critical procedures associated with pediatric resuscitation. It has traditionally been assumed that the clinical practice of pediatric emergency medicine is sufficient for the acquisition and maintenance of these skills. If the relative low acuity of the pediatric emergency medicine patient population provides inadequate opportunity, there is a risk that procedural skills will not be acquired by trainees or maintained by faculty. An accurate description of the frequency with which faculty and trainees perform critical procedures in a pediatric ED would allow for more informed discussion and targeted interventions to reduce this risk.^[3]

We need similar examinations of what we do in EMS.
 

We hypothesized that even in a high-volume pediatric ED, the overall frequency of critical procedures would be very low and the exposure of individual providers to critical procedures negligible.^[3]

Would that be any different from a busy EMS system with a lot of paramedics?
 

From April 1, 2009, through March 31, 2010, 3,067 evaluations were performed on medical and trauma patients in the resuscitation bays. Two hundred sixty-one critical procedures were performed during 194 evaluations, representing 6.3% of all resuscitation bay evaluations and 0.22% (2.2/1,000) of all ED patient evaluations during the study period.^[3]

Click on images to make them larger.
 

That does not look bad.

147 intubations, 9 needle chest decompressions, and 6 synchronized cardioversions in a year.

Except – that is for the entire hospital.

When broken down by the doctor actually performing the procedure
 

Only 39% were able to try to perform any procedure during a year when there were 147 intubations, 9 needle chest decompressions, and 6 synchronized cardioversions.

Look at the range for all critical procedures combined –

0 to 6, with a median of 0.

The white clouds were most of the doctors. Zero critical procedures for the year.

The busiest of the black clouds^[4],^[5],^[6] were only averaging performing one critical procedure every two months.

How much experience do paramedics get when there are a lot of paramedics available to deprive them of experience?

Do we track this and post it for all to see?

What is the level of inexperience in an EMS system that has a paramedic in every seat of every piece of apparatus?

What kind of daily, or even weekly training is required to make up for this absence of experience?
 

Nearly two thirds of our faculty did not perform a single critical procedure during the 12-month study period.^[3]

Does experience matter – Part I

-

Footnotes:

-

^[1] Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study.
Blaivas M.
J Ultrasound Med. 2010 Sep;29(9):1285-9.
PMID: 20733183 [PubMed - in process]

Free Full Text from J Ultrasound Med.

-

^[2] Low quality is identified by inability to use critical thinking
Mon, 20 Aug 2012
Rogue Medic
Article

Click on the image to make it larger.
 

The chart is for all patients treated with needle decompression for suspected tension pneumothorax.

Many patients never had any kind of pneumothorax.

Did any patient have a tension pneumothorax?

We do not know.

-

^[3] The spectrum and frequency of critical procedures performed in a pediatric emergency department: implications of a provider-level view.
Mittiga MR, Geis GL, Kerrey BT, Rinderknecht AS.
Ann Emerg Med. 2013 Mar;61(3):263-70. doi: 10.1016/j.annemergmed.2012.06.021. Epub 2012 Jul 27.
PMID: 22841174 [PubMed - indexed for MEDLINE]

Free Full Text from Annals of Emergency Medicine.

-

^[4] Quantification and perception of on-call podiatric surgical resident workload.
Meyr AJ, Gonzalez O, Mayer A.
J Foot Ankle Surg. 2011 Sep-Oct;50(5):535-6. doi: 10.1053/j.jfas.2011.04.035. Epub 2011 Jun 11.
PMID: 21652228 [PubMed - indexed for MEDLINE]
 

The results of these data suggest that all residents shared a similar workload during the study period without a clinically significant “black cloud” or “white cloud.” However, a difference was found in the perception of which resident was a “black cloud” or “white cloud.”

-

^[5] Black clouds. Work load, sleep, and resident reputation.
Tanz RR, Charrow J.
Am J Dis Child. 1993 May;147(5):579-84.
PMID: 8488808 [PubMed - indexed for MEDLINE]
 

A reputation for difficult on-call experiences was strongly associated with few hours of sleep (r = -.77; 95% confidence interval, -0.49 to -0.91), but not with actual work load measured by the number of admissions, patients, deaths, or other variables. Sleep was the major predictor of reputation (multiple R2 = .567 using multiple linear regression analysis).

CONCLUSIONS:
Some residents did have a black cloud; they slept less, perceived that they worked harder than average, and had a reputation for having difficult on-call experiences. Residents with a black cloud function differently from their colleagues; for example, some may be inefficient, while others may create extra work for themselves. Residency program directors must recognize these functional differences to effectively evaluate and counsel house officers.

-

^[6] Fooled by Randomness: The Hidden Role of Chance in Life and in the Markets
(Google eBook)
Nassim Nicholas Taleb
Random House Digital, Inc.,
Oct 14, 2008
316 pages
Google Books

Believing in black clouds, or other personifications of random occurrences is being fooled by randomness. Dr. Taleb does a good job of describing these errors of judgment.

-

Mittiga, M., Geis, G., Kerrey, B., & Rinderknecht, A. (2013). The Spectrum and Frequency of Critical Procedures Performed in a Pediatric Emergency Department: Implications of a Provider-Level View Annals of Emergency Medicine, 61 (3), 263-270 DOI: 10.1016/j.annemergmed.2012.06.021

-

Blaivas M (2010). Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 29 (9), 1285-9 PMID: 20733183

-

Tanz RR, & Charrow J (1993). Black clouds. Work load, sleep, and resident reputation. American journal of diseases of children (1960), 147 (5), 579-84 PMID: 8488808

-

Meyr, A., Gonzalez, O., & Mayer, A. (2011). Quantification and Perception of On-call Podiatric Surgical Resident Workload The Journal of Foot and Ankle Surgery, 50 (5), 535-536 DOI: 10.1053/j.jfas.2011.04.035

.

EduMedic has a post about making public relations more entertaining, but he seems to be entertaining his crews and only scaring the children.

He creates a game of Russian Roulette with each child holding a wire connected to the defibrillator and the appearance of the defibrillator delivering a shock through only one of the wires.

No shock will be delivered to anyone, but the children do not know this. The children are told the opposite.

The defibrillator is charged. Capacitor whining until it stops. Dramatic tension for the children.

The defibrillator is discharged. Since everyone is only ECG leads, nobody is shocked, but the presenter is supposed to give the appearance of having been shocked.
 

9. Immediately scream in agony, drop your limb lead, and run/jump/cry as you feel is appropriate to convey that you were “shocked.”

10. After catching your breath, thank them for being brave and invite them to bring their friends back for additional demonstrations on the half-hour for the duration of the event. With their full attention at your disposal, it is also the ideal time to discuss relevant public safety messages for your organization.

11. Repeat procedure for the rest of the day, or as long as you can keep a straight face.^[1]

Look at the picture that accompanies this. The medics are laughing, but the children are not.

This could be a set up for explaining to children the dangers of playing with a defibrillator/AED (Automated External Defibrillator), or any other electrical device.

This could be justified as a way of teaching children about the dangers of electric current, or the benefits of electricity when used appropriately. This could be used for explaining that everything has risks, no matter how beneficial it might be.

I do not see any reason for not explaining that nobody was shocked, but nowhere is that suggested. Nowhere in the responses to my comments is that suggested.

What is provided is a series of logical fallacies.

Ahh, mounting opposition for anything in EMS that isn’t evidenced-based. True to form for you, Rogue!^[1]

Nowhere did I criticize this for not being evidence-based.

Logical fallacies have to do with confusion, misdirection, deceit, . . . , but not with anything good.^[2] This is just one of many logical fallacies that will be used by EduMedic in his responses to my comments.
 

“You do not appear to have provided them with any education to justify this.”

1. Re-read the title post. It’s a recipe for laughter. The kids laugh, parents laugh, we laugh. Laughter needs no justification.

2. After this demonstration, I have their undivided attention because they had fun. This is when we talk about what EMS personnel do for the sick & injured and when to call 911.^[1]

The bold type is EduMedic’s.
 

Click here to view the video on YouTube.

We have laughter.

The video shows a way to produce laughter. Nobody really had their fingers cut off. Should we be teaching children to laugh at the misfortune of others?

Laughter needs no justification, because nervous laughter is the same as amusement?

Nervous laughter is a physical reaction to stress, tension, confusion, or anxiety. Neuroscientist Vilayanur S. Ramachandran states “We have nervous laughter because we want to make ourselves think what horrible thing we encountered isn’t really as horrible as it appears, something we want to believe.”^[3]

Having the opportunity to talk to the children afterward is important.

Explaining the difference between a real danger and this fake electrocution is more important. Where does he explain, or even suggest explaining that the electrocution was not real?
 

“You do appear to have taught them that EMS encourages taking unreasonable risks.”

1. At no time is there any risk to anyone involved, only the suggestion of it for the sake of teaching. The same thing is done routinely in HazMat Technician classes with adult students when jars of colored water are presented to the students as something highly toxic. Suddenly the presenter has their full attention.

2. The teachable moment occurs when they quickly realize that there really was no shock. I have yet to see a group of children fail to realize it was purely theatrical. It is at THAT moment when they smile, they laugh, and their minds are open to a new idea… that ambulances and the paramedics on them are not scary after all.^[1]

Nowhere did I suggest that there was a real risk of shock. My objection has been to the lack of explanation to the children.

Even in adult education, we should tell the students that there was no actual dangerous chemical in the container. Otherwise, we are suggesting that the chemicals are safe enough to keep in a classroom.
 

Where is there any suggestion that it should be made clear to the children that there was no real risk at any time?

I’m really trying to understand your preoccupation with the disclosure of an imaginary risk. Remember the context of most any public safety PR event. Law enforcement typically comes with a buckle-up “convincer” or a talking DARE car. However, there are no multi-page waivers to sign prior to riding the convincer, nor are there counselors on hand to debrief children who may have been frightened by an unoccupied vehicle that suddenly comes to life.^[1]

Even more logical fallacies, but they don’t end there.

EduMedic provides clear statement that he does not understand that children do not look at the world the same way adults do.

Should we teach children to take risks, but not teach them the difference between real risk and pretend risk?

By the way, the D.A.R.E. program is an example of a myth. D.A.R.E. has been shown to have the opposite effect of what is intended. I would provide evidence, but EduMedic might claim that by citing research I was justifying some of his use of logical fallacies.
 

A large part of education is about perception.

We are trying to change the way students perceive the world.

Being vague, or omitting information, is not good education. These may be good reasons there are so many myths for me to debunk.

-

Footnotes:

-

^[1] Photo Phriday: Recipe for PR Event Laughter
May 3, 2013 9:00 am
Brian Lilley
Article and comments

-

^[2] Fallacy
Wikipedia
Article

-

^[3] Nervous laughter
Wikipedia
Article

.

Which laryngoscope blade is your favorite?

Does length matter?

Does strength matter?^[1]

Dr. Minh LeCong asks this at his blog PHARM – PreHospital And Retrieval Medicine.

There is also a video that provides some information on blade size.
 

Click here to view the video on YouTube.

One of the problems with the video is the hand position. The laryngoscope should be held so that the hand is touching the blade. I prefer to have my ring finger touching the blade.

The higher the hand is on the handle, the more likely that the handle is used like a slot machine handle, as I demonstrate below.
 

Click here to view the video on YouTube.

The way to intubate is to position the patient before even picking up the laryngoscope (and premedicating with oxygen and whatever else is appropriate), then only advance the blade as far as necessary for each step of laryngoscopy.

1. Find the tongue.

Yay! That was easy.

2. Advance the laryngoscope and find the epiglottis.

Not as easy, but just more important.

3. Lift up (either in the valecula or under the epiglottis – it does not matter) and find the arytenoid structures. The vocal cords are above the arytenoid structures, so there is no need to lift up any farther.

4. Advance the bougie/tube over the arytenoid structures without touching anything else. It isn’t about cleanliness. The biggest problem I see people have when trying to intubate is that they do not avoid everything else in the mouth and end up trying to force the tube.

Force should never be used in the airway.

We should not arm wrestle with the airway. We will lose.

Go ahead and try to force this airway. I double dog dare you.
 

Image credit. It is all in the positioning.
 

The goal of airway management is to out-think the airway, not to out-muscle the airway.

As with martial arts, strength improves with repetition due to the development of muscle memory, even if there is no increase in strength. Technique requires a lot of repetition.

If you have not intubated a mannequin over a thousand times, you are still learning technique. We can always learn more.

We tend to be satisfied with very little practice, as if the patient owes it to us to inhale the tube.

This is ridiculous, but I find that for almost every class I have taught, I intubated the mannequin more times than everyone else in the class combined. I offer to let students practice as much as they want. I offer to help or to leave them alone.

Why is intubation of the airway of another human being so unimportant to so many of us?

Why do so many of us pretend that we are good at intubation?
 

Intubation shouldn’t be that hard, but research repeatedly shows us that we become airway stupid when things do not go as planned – and we are often the cause of the problems with our plan. Even if our plan is not just having the patient inhale the tube.
 

Most adults can be intubated with a #2 Mac or a #2 Miller. A longer blade is only necessary for a patient with an unusually long mandible.

Understanding of the airway is more important than blade size. Any spatula will do.

A blade should be relatively wide and flat. A tongue depressor would work well, but this would require some practice to manipulate the tongue with a tongue depressor. A tongue depressor is wider and flatter than a Miller, so a tongue depressor is better designed than a Miller to lift the tongue out of the way.

Why isn’t the Miller blade designed to lift the tongue out of the way? Was Miller in cahoots with the trial lawyers?

I prefer a Grandview, but a lower profile Grandview would be nice.
 

Click here to view the video on YouTube.

This is from Dr. Richard Levitan’s Airway Cam series.

Dr. Levitan is one of the top airway doctors in emergency medicine. Notice how low his hand is on the blade. It may be someone else manipulating the laryngoscope, but probably someone who has received input from Dr. Levitan on intubation technique.

The wrist is lower than the blade. This makes it more difficult to pull back on the blade and easier to lift up with the blade.

Intubation is not about a long blade, or a strong arm, or pulling back, but many people attempt to intubate using all three of these mistakes.

Intubation is about thinking, preparation, positioning, technique, and lifting the tongue up.

-

Footnotes:

-

^[1] PHARM Poll : Blade choice in direct laryngoscopy – does length or strength matter?
by rfdsdoc
on May 2, 2013
PHARM – PreHospital And Retrieval Medicine
Article

.

I pointed out in Part I^[1] that a critic of EBM (Evidence-Based Medicine) was claiming that each treatment we have discarded was based on evidence – not just any evidence, but on a “Definitive Research Study”.
 

Lets recall that almost every innovation- both good and bad, during my 40 year career has been the result of someones “Definitive Research Study”, including every AHA BCLS/ACLS Revision over that time period, the miracles of Bretyllium and MAST pants,prophylactic Lidocaine, Aminophylline, Ouabaine, Plasmanate, D5W, the use of Narcan for spinal injuries to the use of Leeches and Maggots.

What is a “Definitive Research Study”?
 

Image credit.
 

¹de·fin·i·tive adjective \di-ˈfi-nə-tiv\

1   : serving to provide a final solution or to end a situation <a definitive victory>
 
2   : authoritative and apparently exhaustive <a definitive edition>
 
3   a : serving to define or specify precisely <definitive laws>
 
     b : serving as a perfect example : quintessential <a definitive bourgeois>
 
4   : fully differentiated or developed <a definitive organ>
 
5   of a postage stamp : issued as a regular stamp for the country or territory in which it is to be used
 
— de·fin·i·tive·ly adverb
— de·fin·i·tive·ness noun^[2]

Then a “Definitive Research Study” would be one of the following –

Research that is a final solution (answer) to the question of whether the treatment works?

Research that is authoritative and apparently exhaustive.

Research that serves to define or specify precisely.

Research that serves as a perfect example : quintessential research.

Research that is fully differentiated or developed.
 

The examples provided by the EBM critic do not come close to fitting any of those definitions.
 

Click here to view the video on YouTube.

Look here, brother, who you jiving with that cosmik debris?

What causes so many people to be so delusional about science?

Ignorance.

The problem is that this ignorance should result in the silence of these anti-science propagandists, but they regularly claim to know more than scientists about what scientists study.

The AHA (American Heart Association) does not use terminology like “Definitive Research Study”. According to the AHA, the highest level of evidence requires more than one study.

What kind of study would come close to being definitive?
 

In terms of external validity, the critical care transport setting may be different from other prehospital situations. In fact, although much of the literature describing fentanyl’s use comes from the air medical (high acuity) sector, perhaps the best study to date comes from a ground EMS service by Kanowitz et al. described above (8). This study was a retrospective chart review that differs from our prospective study with regards to design, but has similar conclusions. The authors of that earlier report found, for example, that of 2129 patients receiving fentanyl, only 12 had a vital sign abnormality that was possibly attributed to the opioid.^[3]

Even a study with thousands of patients receiving the same treatment with no clear evidence of any adverse effects to any patients is not definitive.

What ACLS treatment is based on similar evidence?

Definitely not bretylium.

Definitely not prophylactic lidocaine.

Can anyone name even one emergency treatment, based on anything that could be considered definitive research, that has been discarded.

Not replaced by an improved (safer and/or more effective treatment), but discarded.

-

Footnotes:

-

^[1] Misunderstanding of Evidence-Based Medicine – Part I
Sun, 17 Mar 2013
Rogue Medic
Article

-

^[2] Definitive
merriam-webster.com
Definition

-

^[3] Fentanyl in the out-of-hospital setting: variables associated with hypotension and hypoxemia.
Krauss WC, Shah S, Shah S, Thomas SH.
J Emerg Med. 2011 Feb;40(2):182-7. Epub 2009 Mar 27.
PMID: 19327928 [PubMed - in process]

Full Text PDF Download at medicalscg.

.

Representative Andrea Boland is trying to make it harder to vaccinate children.

Why?

She appears to be just another scientifically illiterate person who thinks that chemical names are scary, even though there is no medical justification for her alarmist bill.

Vaccines are probably the safest and most effective medicines we have.

 

Image credit.
 

The measure, LD 754, sponsored by Democratic Rep. Andrea Boland, ran into stiff opposition from doctors, who said that requiring ingredients be disclosed specifically for vaccines — while not imposing similar requirements for antibiotics and prescription drugs — would signal that vaccines are disproportionately dangerous.^[1]

Is anyone trying to hide the ingredients of vaccines?

Absolutely not.

The ingredients for every vaccine are available, but before you start making the mistake of assuming that scary sounding names are dangerous, take less than 4 minutes to watch the video below.
 

Click here to view the video on YouTube.

Why only the ingredients of vaccines?

To make them seem scary.

In case you think that Rep. Boland is trustworthy, here is what she says about vaccine safety.

“When you read some of [the ingredients], it does sound kind of scary. The provider is there to counsel their patients, and they can assure them that they will not have any serious side effects and it’s the best thing to do.”^[1]

It’s the best thing to do.
 

If vaccination is the best thing to do, why create obstacles to vaccination?

Is Rep. Bolton trying to push some sort of hidden agenda?

Here is the information provided on her government web page.

Occupation: Self-Employed Title Examiner; Independent Nutraceutical Distributor^[2]

Rep. Bolton appears to be letting her personal nutraceutical business interests get between her and what is best for the children she is supposed to represent.

If you have a bit more time than the less than 4 minutes it took to watch the video, then listen to a 33 1/2 minute podcast, where Dr. Mark Crislip explains what is wrong with a silly claim by a naturopath.^[2] “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims.” by David Mihalovic, ND. Really?

If you believe that vaccines are dangerous, then you need to listen to this podcast.

-

Footnotes:

-

^[1] Sanford lawmaker wants doctors to disclose vaccine ingredients
By Matthew Stone, BDN Staff
Posted April 29, 2013, at 3:27 p.m.
Bangor Daily News
Article

-

^[2] QuackCast 44. Nine questions.
Dr. Mark Crislip
Quackcast
Nine questions, none answers. An ND suggests there are 9 questions that pro-vaccine proponents can’t answer. Ha. My 12 year old can find the answers.
Podcast in mp3 format – click to play or right click and save to download.
 

QuackCast 44. Nine questions, none answers. An ND suggests there are 9 questions that pro-vaccine proponents can’t answer. Ha. My 12 year old can find the answers.

The print version, with links to the referenced research, is at the link below.

Nine Questions, Nine Answers.
Published by Mark Crislip
May 07, 2010
Science-Based Medicine
Article

.

Intravenous oxygen delivery that works?

Maybe temporary oxygenation, but not yet.

Will this change the approach to CICV (Can’t Intubate, Can’t Ventilate) patients?

No, but it may change the approach to CICO (Can’t Intubate, Can’t Oxygenate) patients.

The distinction is important. If we can deliver oxygen without ventilation, we can avoid some of the problems of hypoxia, but we will still have to deal with the acidosis that results from the inability to eliminate CO₂ (Carbon DiOxide).
 

In the early 1900s, intravenous administration of oxygen gas was used in attempts to relieve refractory cyanosis (4–7). Most reported that spontaneously breathing, cyanotic animals exhibited signs of pulmonary embolism at infusion rates in excess of 0.2 to 1 ml/kg per minute and required frequent pauses in the infusion (4, 5); . . . None of these studies documented an increase in oxygen content in the blood as a result of the intervention.^[1]

Try walking up several flights of stairs while only breathing through your nose. You will become short of breath very quickly.

Unless you are in truly horrible shape, it is not a lack of oxygen that is causing you to become short of breath. It is the inability to remove CO₂ (Carbon DiOxide) that is the problem.

Most of us breathe because of a buildup of CO₂, not because of a lack of oxygen.
 

The reflexive response of some people might be to give the anti-acidosis drug NaHCO₃ (sodium bicarbonate). We will ignore the sodium, which at 5.8% in NaHCO₃ is over 6 times the concentration of the NSS (Normal Saline Solution – 0.9% sodium) we routinely give. The sodium in NaHCO₃ may be effective for treating sodium channel blocking drugs, such as antidepressnts, antiseizure medications, antiarrhythmics, and antivirals.^[2]

The sodium is not the real danger. The bicarbonate (HCO₃^-) is the problem. When binding with the excess hydrogen ions to neutralize metabolic acidosis, CO₂ is produced.
 

HCO₃^- + H⁺

Produces:

CO₂ + H₂O
 

a patient with complex airway anatomy and difficulty maintaining oxygenation using basic airway maneuvers could avert a hypoxemic crisis during a prolonged intubation attempt. To date, safe and effective intravascular delivery of oxygen gas has not been realized.^[1]

In the cute little bunnies used in the study (7 LOM [Lipidic Oxygen–containing Microparticles] and 6 Control), these were the results.
 

Click on images to make them larger.
 

Oxygen saturation remained between 40% and 60% with the LOM, but that was much better than the less than 20% for the controls. since the study animals received LOMs titrated to an arterial oxygen tension of greater than 30 mmHg, this is not a surprise. The controls just received fluid at a similar rate.
 

CO₂ more than doubled for both groups.

Providing oxygen does nothing to remove CO₂.
 

When CO₂ increases, the pH will decrease (acidosis will increase).

Sodium bicarbonate will not decrease the acidosis for these patients.

Sodium bicarbonate will increase the acidosis for these patients.

Sodium bicarbonate produces CO₂, which must be removed by ventilation. If we are giving LOM to patients we can adequately ventilate, maybe we do not understand what we are doing.

We should only give sodium bicarbonate to a patient who is well ventilated – unless we are trying to kill the patient.
 

In (F) and (G), data are means ±SEM. The blue lines end at 10.2 min because no animals treated as controls had spontaneous circulation after that time and received chest compression–only cardiopulmonary resuscitation (CPR) during the remainder of asphyxia. (H) Kaplan-Meier plot of animals experiencing cardiac arrest during asphyxia (left; P =0.0002, log-rank test), restoration of mechanical ventilation (shaded box), and subsequent recovery and observation (right).^[1]

None of the bunnies reported any near-death experiences.

Consider the time involved. Many in the media have been reporting this as a way to provide half an hour of apneic oxygenation. That is ridiculously optimistic. This will be something that might provide an extra 5-10 minutes to manage a hypoxic patient, if the patient has not already died due to the hypoxia.

5-10 minutes can be the difference between life and death.

Don’t believe me?

Hold your breath for 10 minutes. Just stop breathing and hold your breath.^[3]

Without LOMs, all of the bunnies were pulseless after a little more than 10 minutes, but at 15 minutes, when ventilation was resumed, almost all of the LOM bunnies still had pulses (6 out of 7).

LOMs are not just to make it possible to deliver a patient with a pulse to the hospital, so that we can say that They didn’t die in the ambulance.

That is not changing anything.

LOMs are to provide time for us to provide an airway – if this ever demonstrates safety and efficacy in humans.

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Footnotes:

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^[1] Oxygen gas-filled microparticles provide intravenous oxygen delivery.
Kheir JN, Scharp LA, Borden MA, Swanson EJ, Loxley A, Reese JH, Black KJ, Velazquez LA, Thomson LM, Walsh BK, Mullen KE, Graham DA, Lawlor MW, Brugnara C, Bell DC, McGowan FX Jr.
Sci Transl Med. 2012 Jun 27;4(140):140ra88. doi: 10.1126/scitranslmed.3003679.
PMID: 22745438 [PubMed - indexed for MEDLINE]

Free Full Text Download in PDF format from medlive.cn
 

At the end of the asphyxial period, mechanical ventilation was restored with 100% oxygen until return of pulsations (in animals receiving chest compressions) and then titrated downward to achieve arterial saturations of >92%. Animals achieving return of spontaneous circulation after relief of asphyxia were treated with standard intensive care management, including inotropic support (dopamine, 2 to 10 mg/kg per minute, intravenous infusion) to maintain MABP of at least 40 mmHg during the follow-up period. Hyperthermia was avoided by passive ambient cooling (goal, 34 to 35° C). Animals were sacrificed 90 min after the end of asphyxia for lab and histology sampling.

Everyone seems to be using therapeutic hypothermia and trying to avoid giving too much oxygen.

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^[2] Management of sodium-channel blocker poisoning: the role of hypertonic sodium salts.
Di Grande A, Giuffrida C, Narbone G, Le Moli C, Nigro F, Di Mauro A, Pirrone G, Tabita V, Alongi B.
Eur Rev Med Pharmacol Sci. 2010 Jan;14(1):25-30. Review.
PMID: 20184086 [PubMed - indexed for MEDLINE]

Free Full Text in PDF format from EuropeanReview.org
 

As more substances having sodium-channel blocking properties become available, the incidence of this poisoning may be expected to increase, and clinician, particularly the emergency physician, should be familiar with this potential fatal condition.

A little evidence supports the treatment with hypertonic sodium salts, and current recommendations have not been based on randomized clinical trials.

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^[3] Longest time breath held voluntarily (male)
Guinness World Records
Web page.
 

The longest time holding the breath underwater was 22 min 00 sec by Stig Severinsen (Denmark) at the London School of Diving in London, UK, on 3 May 2012.

Stig was allowed to hyperventilate with oxygen prior to the attempt, and did this for 19 minutes and 30 seconds.

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Kheir, J., Scharp, L., Borden, M., Swanson, E., Loxley, A., Reese, J., Black, K., Velazquez, L., Thomson, L., Walsh, B., Mullen, K., Graham, D., Lawlor, M., Brugnara, C., Bell, D., & McGowan, F. (2012). Oxygen Gas-Filled Microparticles Provide Intravenous Oxygen Delivery Science Translational Medicine, 4 (140), 140-140 DOI: 10.1126/scitranslmed.3003679

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