Esmolol for Refractory VFib

Here’s a good post by Bryan Hayes on the state of evidence for esmolol in refractory VF. There is not a huge amount of data for this, but what there is seems promising. It would seem a reasonable thing to study in a mature EMS setting, and certainly a great deal cheaper than certain mechanical devices…

The PharmERToxGuy

Up until two years ago, beta blocker use for refractory ventricular fibrillation (VFib) had only been studied in animal models with sporadic human case reports. Two studies in humans have now been published and may provide some guidance in managing this difficult-to-treat condition.

View original post 365 more words

Posted in Uncategorized | Leave a comment

Angling for Trouble? Catch and Release for Heroin Overdose.

Ok, I’ll make this quick, as it’s half time during the Bledisloe Cup, and nothing is more important than seeing Straya get beaten (again).  Therefore, no references – but I’ll follow up with some data once another study has been published (in the pipeline)


Continue reading

Posted in Uncategorized | 1 Comment

Why I’m not thanking a Paramedic

According to my social media streams, yesterday was “Thank a Paramedic Day”. This seems to have been taken up with enthusiasm by various members of the public who have been telling their stories of being treated by paramedics, or more interestingly, just being treated kindly.  As a paramedic, this all feels quite nice in a way – a recognition of the work we do and how society values it.  But I have some misgivings.

It seems forced. I’m sure there are nothing but good intentions involved, but if I’m to be thanked I’d much rather it be a spontaneous thing in response to a specific thing that I’ve done.  I’m not sure that gratefulness-by-category is all that meaningful.

Sometimes a job is just a job.  I’m often told by non-medical people that they couldn’t do my job.  That may be true, but let’s be honest, I probably couldn’t do their job.  Fair’s fair.  I chose this job and I choose to remain doing it.  It wasn’t forced on me. My work benefits other people, but so do lots of occupations – just usually less conspicuously.

This is not America. A culture seems to have evolved in the USA since the 9/11 attacks where uniformed military personnel are reflexively “thanked for their service”.  Soldiers of my acquaintance have told me a number of times that this has become a kind of social nicety, an obligation, rather than a meaningful act of thanks. It’s lost some of its meaning by becoming encouraged.

I’m not a hero. Heroes go above and beyond in a dramatic way.  I am paid for what I do and the requirements of my job are outlined quite clearly.  Turning up to the “office” in the morning isn’t exactly heroism in my mind.  Friends of mine have started noticing that their takeaway coffees have been having messages written on them like “free coffee for heroes”. We’re not heroes, we’re just people doing a job. Accepting that coffee now feels awkward because of the message. I’m often given free coffee because of my uniform, so my response is to tip the barista the price of the beverage.

The job itself is usually reward enough. People may not believe this, but this is an intensely rewarding job. We all have our bad days, but most of the time the job is hugely satisfying. Adding compulsory adulation on to the top isn’t icing on the cake – it’s almost patronising in a strange way.

Please don’t take this to mean that I don’t appreciate the gestures of individual, heartfelt thanks that I receive in the course of my duties.  They mean the world to me and I am intensely grateful. I am enormously proud of the work that I do. But making this a cultural requirement takes something away from it.  Thank me, but do it in person for something I did for you. That’s when it means something.


Posted in Uncategorized | 3 Comments


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.


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…

Continue reading

Posted in Pharmacology, Research, Resuscitation | 3 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.


Link | Posted on by | Leave a comment

Christmas Greetings

I hate Christmas

Continue reading

Posted in Mental Health | 1 Comment

Robbie Rants: Professionalism

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




Posted in Uncategorized | Leave a comment

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

Posted in Uncategorized | 2 Comments