Tamiflail

Some people may remember the Great Swine Flu Epidemic of several years ago.  Paramedics and other frontline operators were wearing tyvek suits on a daily basis and the febrile media was spending most of its time freaking out about the end of the world.  We were all excited in particular about Tamiflu, a medication which was supposed to shorten the course of the illness and save lives.

Except that Roche, the company that makes it, was distinctly tardy about releasing actually useful science about the effectiveness of the drug.  Rather, they selectively released flattering information which painted their drug in a good light, and governments around the world spent hundreds of millions of dollars stockpiling it.  With no good evidence.

Well, after a lot of prodding, Roche has finally released the evidence. And it is… shall we say… somewhat lacking. Ben Goldacre, British doctor and journalist, and champion of integrity in medical research, has written about it:

So does Tamiflu work? From the Cochrane analysis – fully public – Tamiflu does not reduce the number of hospitalisations. There wasn’t enough data to see if it reduces the number of deaths. It does reduce the number of self-reported, unverified cases of pneumonia, but when you look at the five trials with a detailed diagnostic form for pneumonia, there is no significant benefit. It might help prevent flu symptoms, but not asymptomatic spread, and the evidence here is mixed. It will take a few hours off the duration of your flu symptoms. But all this comes at a significant cost of side-effects. Since percentages are hard to visualise, we can make those numbers more tangible by taking the figures from the Cochrane review, and applying them. For example, if a million people take Tamiflu in a pandemic, 45,000 will experience vomiting, 31,000 will experience headache and 11,000 will have psychiatric side-effects. Remember, though, that those figures all assume we are only giving Tamiflu to a million people: if things kick off, we have stockpiled enough for 80% of the population. That’s quite a lot of vomit.

Source

Seems like our governments fell for it hook, line and sinker.  Have a read of the Cochrane review here and prepare to weep.

Posted in Ethics, Pharmacology, Respiratory | Tagged , , , | Leave a comment

The drugs don’t work…

At least in cardiac arrest that is.  Maybe…

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Posted in Pharmacology, Research, Resuscitation | 4 Comments

Here’s a link to an interesting article on the pathophysiology, and more importantly, the significance of febrile illnesses.

Science-Based Medicine – Fever Phobia

Many people are terrified of fever, especially in children, with no real justification.  The key takeaways are that you should only worry about elevated temperatures if your patient

  • Has a neurological malformation of the hypothalamaus; or
  • Has suffered environmental hypothermia; or
  • Is taking certain uncommon medications which can inhibit temperature regulation

For everyone else, relax!  Fever is a normal part of the healing process. There is no need to interfere in this natural process unless the patient is unreasonably pained or uncomfortable.

 

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Christmas Greetings

I hate Christmas

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Posted in Mental Health | 1 Comment

Robbie Rants: Professionalism

Sorry for the technical difficulties, this time everything should work….

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Professionalism

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Own the OG

I am not by nature a boastful person.  In fact, I have issues with self confidence.  Many might find this hard to believe, but that is only because I work hard to present a calm, confident exterior, as I think it benefits everyone at a job if I keep my inner turmoil to myself.

However, one thing I reckon I do ok at is the technical side of being a paramedic.  The old cry of “they can never get a drip in me” is merely a challenge, and I have never met an airway I can’t secure somehow.

But we all have a nemesis, and mine is the gastric tube.  I can happily jab the wriggliest of veins through the adiposist of tissues (pretty sure that’s a word), slot an ETT in the grade 4ist of airways, and then come horribly unstuck trying to pass an OG tube.  Nope.  Cannot do it.  Not happening.  Fuck it, you do it while I cry in the corner.

I keep my OG tubes in the fridge to keep them stiff and help me get  them in, but even the stiffest of tubes still will not go where I want it (oo ‘er!)  Now, however, I have a new trick that I can’t wait to try, thanks to some of the smartest and nicest blokes in #FOAMed, the ScanCrit crew.  Check out Daniel’s post “Own the O.G.” over at ScanCrit.  I don’t want someone to need an OG, but by  god I want to be there when they do so I can try this!

 

Update: it works! I felt like I was some kind of wizard today: intubated a cardiac arrest pt during CPR, got ROSC, loaded up, on the vent, then… Bam! OG goes in like a boss! No sweating, no swearing, no giving up and sulking.

This has transformed my life!

Posted in Airway | 1 Comment

A great day for Australian Paramedics…

Today is a great day in the history of paramedicine in Australia.  At long last the heads of government in Australia have all finally supported paramedic registration (thanks NSW…)

This is a momentous occasion and a fantastic step forward for the profession of prehospital care.  We all will benefit from this, but none more so than our patients.

To all who have worked towards this and given your time selflessly, my thanks and congratulations.  You are all a credit to our profession and to your selves.  Thank you.

Paramedics Australasia Facebook

Hon. Jill Hennesy twitter

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Robbie Rants: HEMS Requests

A short podcast, thanks to the PAIC2015 FOAMed attendees.  I hope you’re happy with what you’ve started!

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HEMS Request

 

Posted in Uncategorized | 3 Comments

Can I get HEMS?

I’m back up in Ballarat at the moment, working in the control room, and one of the most common question I get is “can we have HEMS?”.  The answer is often, but not always “yes”, however there are a number of things that need to be considered before a helicopter is launched.  We will take a brief look at air operations in the post, however please bear in mind that this is from the point of view of me, a clinician.  I am not a HEMS medic, I am not a Flight Coordinator, so everything I write here must be treated as suspect.  Much like all my other posts…

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PAIC #FOAMed Workshop Introduction.

Hi everyone.

Unfortunately I am unable to make it to the Paramedics Australasia conference in Adelaide this year.  I was looking forward to taking part in the FOAMed workshops, however other events require my attendance, so I won’t be there.

But fear not!  You don’t have to miss out on me making noises with my face at you; thanks to the wonders of modern technology, I am able to transcend time and space and talk to you all in person!  Sort of.

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Posted in Uncategorized | 1 Comment