RTs intubating...

[Lexdiamondz]

I recently took a per-diem gig at a hospital that historically staffed their ED with a lot of FM and IM trained guys. RTs did most tubes, and I was told they were "good"

Last night, had a patient that needed to be tubed (urgently, but non-emergently) so I asked the nurse to page RT to bring a vent. I find a COW to go throw in some orders for RSI meds and a post-tube CXR and I turn around 5 mins later and this RT is hacking away at my patient's oropharynx, no suction set up, patient malpositioned, sats in the 80s.

I ask him to pull out the laryngoscope and start bagging before the patient desats any further and I see a bloody Mac 3. At this point I ask RT to step aside, bag the patient back up, grab a bougie and suction and tube the patient myself, no issues.

This AM I get an email saying that the RT complained I was "unprofessional" - even though I never said anything untoward against him and he performed an invasive procedure on my patient without telling me and was failing at it. I called the vice chair for the site and gave my side and he seemed to be pretty understanding but is it worth it to even keep this job if this is the culture at this institution? Has anyone worked in a shop where RT did airways and had issues^

I'm a new grad and can use the extra money towards loans and saving towards a house but the signouts I've gotten from these FM guys have been mostly hot trash and now with this incident I'm wondering if I should just cut ties and try to just pick up extra shifts at my main gig instead.

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[deleted941485]

I recently took a per-diem gig at a hospital that historically staffed their ED with a lot of FM and IM trained guys. RTs did most tubes, and I was told they were "good"

Last night, had a patient that needed to be tubed (urgently, but non-emergently) so I asked the nurse to page RT to bring a vent. I find a COW to go throw in some orders for RSI meds and a post-tube CXR and I turn around 5 mins later and this RT is hacking away at my patient's oropharynx, no suction set up, patient malpositioned, sats in the 80s.

I ask him to pull out the laryngoscope and start bagging before the patient desats any further and I see a bloody Mac 3. At this point I ask RT to step aside, bag the patient back up, grab a bougie and suction and tube the patient myself, no issues.

This AM I get an email saying that the RT complained I was "unprofessional" - even though I never said anything untoward against him and he performed an invasive procedure on my patient without telling me and was failing at it. I called the vice chair for the site and gave my side and he seemed to be pretty understanding but is it worth it to even keep this job if this is the culture at this institution? Has anyone worked in a shop where RT did airways and had issues^

I'm a new grad and can use the extra money towards loans and saving towards a house but the signouts I've gotten from these FM guys have been mostly hot trash and now with this incident I'm wondering if I should just cut ties and try to just pick up extra shifts at my main gig instead.

You got preempted by the RT. Now you’re playing defense. You have to realize that RTs and other people at that lower levels of healthcare the game is all about telling on people and throwing them under the bus before they throw you under the bus.

I saw a lot of messed up **** and kept my mouth shut…seemed to work better than speaking up. Seen Enough friends get ****ed for speaking up. If it’s so egregious just quit.

 

[bravotwozero]

I’ve worked at places where RTs can tube, but they have to ask the doc first before doing anything.

 

[Volatile]

I do a lot of locums work as an anesthesiologist and I’ve lost count how many times I’ve had to bail out RT intubations. I’m not saying it’s terrible everywhere, but at my n=2 hospitals where they intubate, it’s not good :/

 

[Jabbed]

I've allowed RTs and mid-levels to intubate, but only VL and while I'm at the head of the bed anyway to direct and/or take-over.

Based on what you're describing in general, I would not choose to work at your site if I had a choice.

 

[thegenius]

This AM I get an email saying that the RT complained I was "unprofessional" - even though I never said anything untoward against him and he performed an invasive procedure on my patient without telling me and was failing at it. I called the vice chair for the site and gave my side and he seemed to be pretty understanding but is it worth it to even keep this job if this is the culture at this institution? Has anyone worked in a shop where RT did airways and had issues^

I'm a new grad and can use the extra money towards loans and saving towards a house but the signouts I've gotten from these FM guys have been mostly hot trash and now with this incident I'm wondering if I should just cut ties and try to just pick up extra shifts at my main gig instead.

I would look for a new job. Not so much that the RT doesn't know what he's doing. Intubating is a rare thing. It's getting shiiiity signouts from FM guys and overall working in an ER where EM isn't actually practice according to our standards.

 

[Angry Birds]

My RTs are just Albuterol Dispensing Machines. I simply can’t imagine them intubating.

 

[turkeyjerky]

I would quit. Some of these small hospitals have weird, insular cultures and I think you stumbled upon one. They're used to old docs who're burnt out hulks of human beings. You're not the first doctor they've played this game with and chased out.

As far as RTs intubating, I've heard of this practice but not yet experienced it. Can't imagine it's anything less than horrifying. Honestly, I cannot imaging letting anyone else tube a patient, other than a medical student or resident, while I was in the room. What about optimizing first-pass success? F that.

 

[Tenk]

 

[EMhawkeye]

I would look for a new job. Not so much that the RT doesn't know what he's doing. Intubating is a rare thing. It's getting shiiiity signouts from FM guys and overall working in an ER where EM isn't actually practice according to our standards.

Yeah dumping on your colleagues is a bad look. Lest we not forget that family medicine trained guys were the founding fathers of the specialty. Many of whom have been staffing ED's since you were in diapers.
It is possible to acknowledge the benefits of dedicated emergency medicine residency training without taking a dump on other physicians practicing emergency medicine safely and effectively. There are bad apples that are fm/ im trained and many bad apples as well that are EM trained.
Your professionalism needs work.

 

[Lexdiamondz]

I would quit. Some of these small hospitals have weird, insular cultures and I think you stumbled upon one. They're used to old docs who're burnt out hulks of human beings. You're not the first doctor they've played this game with and chased out.

As far as RTs intubating, I've heard of this practice but not yet experienced it. Can't imagine it's anything less than horrifying. Honestly, I cannot imaging letting anyone else tube a patient, other than a medical student or resident, while I was in the room. What about optimizing first-pass success? F that.

I think you may be right. Honestly the money is good but I don't think its worth this kind of stress dealing with the culture here. Time to go.

Yeah dumping on your colleagues is a bad look. Lest we not forget that family medicine trained guys were the founding fathers of the specialty. Many of whom have been staffing ED's since you were in diapers.
It is possible to acknowledge the benefits of dedicated emergency medicine residency training without taking a dump on other physicians practicing emergency medicine safely and effectively. There are bad apples that are fm/ im trained and many bad apples as well that are EM trained.
Your professionalism needs work.

These are the very guys I was talking about. IDK if I would call the care they administer safe - the local practice patterns here include giving clonidine for agitated delirium instead of benzos, nobody (not even RT) knowing how to use a video laryngoscope and getting abdominal XR for blunt abd trauma.

 

[EMhawkeye]

I think you may be right. Honestly the money is good but I don't think its worth this kind of stress dealing with the culture here. Time to go.




These are the very guys I was talking about. IDK if I would call the care they administer safe - the local practice patterns here include giving clonidine for agitated delirium instead of benzos, nobody (not even RT) knowing how to use a video laryngoscope and getting abdominal XR for blunt abd trauma.

So anecdote?
3rd year EM resident 6 months away from board eligibility calls to admit a person with new onset CHF. Mildly hypoxic, pulmonary edema, 4+ pitting edema. No diuretics given.
When asked why she didn't give lasix: "Well his bp is 110/70 and I didn't want to bottom him out."
Oblivious to the fact that afterload reduction will increase cardiac output. Also oblivious to the need for ionotropes in CHF with tenuous hemodynamics to facilitate diuresis.
20 mg IV lasix given by admitting resident and bp improved to 130/90.


Another chestnut I have.
Senior em resident calls to admit a case of diverticulitis.
Senior EM resident asks the IM resident "They're allergic to cipro, what do you think I should give?"



We all have these anecdotal stories. Painting one group with a large group is poor logic and unprofessional.

 

[Lexdiamondz]

So anecdote?
3rd year EM resident 6 months away from board eligibility calls to admit a person with new onset CHF. Mildly hypoxic, pulmonary edema, 4+ pitting edema. No diuretics given.
When asked why she didn't give lasix: "Well his bp is 110/70 and I didn't want to bottom him out."
Oblivious to the fact that afterload reduction will increase cardiac output. Also oblivious to the need for ionotropes in CHF with tenuous hemodynamics to facilitate diuresis.
20 mg IV lasix given by admitting resident and bp improved to 130/90.


Another chestnut I have.
Senior em resident calls to admit a case of diverticulitis.
Senior EM resident asks the IM resident "They're allergic to cipro, what do you think I should give?"



We all have these anecdotal stories. Painting one group with a large group is poor logic and unprofessional.

Sounds like you need to train your residents better.

Joking aside, no we shouldn't dump on our colleagues but overlooking egregious practice patterns by people who weren't trained to do this job in the name of "professionalism" is poor logic as well.

 

[southerndoc]

RT intubates on the floors sometimes, but I've never worked in an ER where it's common practice for them to intubate. I worked at one shop where two physicians always had RT intubate their patients, but the doc takes the tube at every site with exception to those two now-retired physicians.

 

[Apollyon]

Mentioning "professionalism" twice in 2 posts is remarkable. That is not, usually, the first thing on an astute practitioner's mind.

 

[EMhawkeye]

Mentioning "professionalism" twice in 2 posts is remarkable. That is not, usually, the first thing on an astute practitioner's mind.

Advocating for patient safety is all well and good without giving a middle finger to thousands of our colleagues.

 

[Apollyon]

Advocating for patient safety is all well and good without giving a middle finger to thousands of our colleagues.

Well, at least you didn't put "professionialism" in there. But, if everyone has an anecdote, while not data, there is smoke there. Whereas one group is casting aspersions, you are taking the opposite tack, and sound like you're giving the entire cohort a pass. Maybe some significant percentage, while not all, or maybe even a minority, actually do deserve the finger.

 

[EMhawkeye]

Well, at least you didn't put "professionialism" in there. But, if everyone has an anecdote, while not data, there is smoke there. Whereas one group is casting aspersions, you are taking the opposite tack, and sound like you're giving the entire cohort a pass. Maybe some significant percentage, while not all, or maybe even a minority, actually do deserve the finger.

I do love that petty political BS is so important to people here. Had it only gone slightly differently, EM would have been a fellowship of family medicine and not an independent residency. Love the new generation of EP's is so uppity to dump on the roots of the specialty to make themselves feel superior.
Having to denigrate someone else to demonstrate how good you are 🚩🚩🚩
Being an emergency physician is an awesome thing. Having dedicated residency training to do it is great. It does not innately make you a better clinician. Period.

 

[Lexdiamondz]

I do love that petty political BS is so important to people here. Had it only gone slightly differently, EM would have been a fellowship of family medicine and not an independent residency. Love the new generation of EP's is so uppity to dump on the roots of the specialty to make themselves feel superior.
Being an emergency physician is an awesome thing. Having dedicated residency training to do it is great. It does not make innately make you a better clinician. Period.

In addition to working with those folks today, I was also trained by many of them in residency. All would note the vast differences in IM training in 1970 and EM training in 2021. Not one would advocate the position that you're seemingly espousing here. Not. A. Single. One.

The very reason why those who built this field created a new specialty was because the training in their base specialties (IM, FM, Surgery) were not sufficient to safely and efficiently provide care to the full breadth of pathology that presents in the typical American emergency department. Nobody is saying those pathways make bad clinicians, but by design none of those were built to make good Emergency clinicians.

Nobody would stick up for an EP who tried to do critical care, anesthesiology or cardiology without dedicated training in those fields, and any EP who tried to and make a mistake would immediately be skewered for "practicing out of scope". So why should we be any different?

Following your logic, we should be content with barbers inducing patients with chloroform rags and performing open choleys since they are the "ancestors" of modern-day surgeons in the anglophone world.

Anyway, this is wayyyyyyy off topic and not in the original spirit of the thread I started. This topic has been discussed ad nauseam

 

[EMhawkeye]

In addition to working with those folks today, I was also trained by many of them in residency. All would note the vast differences in IM training in 1970 and EM training in 2021. Not one would advocate the position that you're seemingly espousing here. Not. A. Single. One.

The very reason why those who built this field created a new specialty was because the training in their base specialties (IM, FM, Surgery) were not sufficient to safely and efficiently provide care to the full breadth of pathology that presents in the typical American emergency department. Nobody is saying those pathways make bad clinicians, but by design none of those were built to make good Emergency clinicians.

Nobody would stick up for an EP who tried to do critical care, anesthesiology or cardiology without dedicated training in those fields, and any EP who tried to and make a mistake would immediately be skewered for "practicing out of scope". So why should we be any different?

Following your logic, we should be content with barbers inducing patients with chloroform rags and performing open choleys since they are the "ancestors" of modern-day surgeons in the anglophone world.

Anyway, this is wayyyyyyy off topic and not in the original spirit of the thread I started. This topic has been discussed ad nauseam

Strawman much?

Yes I agree with regard to the RT. Nobody should do anything to your patient without your permission.

 

[sylvanthus]

Strawman much?

Yes I agree with regard to the RT. Nobody should do anything to your patient without your permission.

Ugh just read the guys post history sometime for some perspective. Makes sense now. Guy was berating people for having too many interviews. The condescension and holier than thou attitude is strong with this one.

 

[EMhawkeye]

Ugh just read the guys post history sometime for some perspective. Makes sense now. Guy was berating people for having too many interviews. The condescension and holier than thou attitude is strong with this one.

Condescension? Such a big word lol. Did you read the original post on this thread?
Condescension is the first year attending coming out of residency thinking he's the shiz and painting thousands of other practicing physicians providing emergency care as sub standard providers either directly or by inference.
Condescension is bringing up somebody's post history from residency application years ago when you can't refute a point on its merits and instead decide to side step into a non sequitur.
Reading my post history? Wish I had that kind of free time.

 

[Lexdiamondz]

Condescension? Such a big word lol. Did you read the original post on this thread?
Condescension is the first year attending coming out of residency thinking he's the shiz and painting thousands of other practicing physicians providing emergency care as sub standard providers either directly or by inference.
Condescension is bringing up somebody's post history from residency application years ago when you can't refute a point on its merits and instead decide to side step into a non sequitur.
Reading my post history? Wish I had that kind of free time.

Pot really calling kettle black here

 

[EMhawkeye]

Pot really calling kettle black here

Trading anecdote for anecdote.
I judge individuals by their own actions and clinical skills; not the the certification after their name, the place they finished residency, etc.
You can see how others could take what you wrote as an inference against a large group of practicing physicians and be offended?

 

[sylvanthus]

Trading anecdote for anecdote.
I judge individuals by their own actions and clinical skills; not the the certification after their name, the place they finished residency, etc.
You can see how others could take what you wrote as an inference against a large group of practicing physicians and be offended?

Goooo awwaayyyyy

 

[EMhawkeye]

Goooo awwaayyyyy

I will to allow you to have sometime to sit down and read some post histories.

 

[Lexdiamondz]

Trading anecdote for anecdote.
I judge individuals by their own actions and clinical skills; not the the certification after their name, the place they finished residency, etc.
You can see how others could take what you wrote as an inference against a large group of practicing physicians and be offended?

If someone chooses to make inferences and be offended about a thread asking whether my side gig is ****ty or not, that is their problem.

Mind you don’t crack your head open falling off that high horse of yours, friend.

 

[VA Hopeful Dr]

If someone chooses to make inferences and be offended about a thread asking whether my side gig is ****ty or not, that is their problem.

Mind you don’t crack your head open falling off that high horse of yours, friend.

I'm FM and your post didn't read to me as anything negative about FM as a specialty. It was pretty explicitly directed specifically at the FPs working at this one ED.

I've known EPs who I think weren't any good (I think we've all known specific doctors in every specialty who just aren't good), but outside of angry venting its almost never an indictment against the specialty as a whole.

Except Functional Medicine physicians. Screw those shysters.

 

[sylvanthus]

I'm FM and your post didn't read to me as anything negative about FM as a specialty. It was pretty explicitly directed specifically at the FPs working at this one ED.

I've known EPs who I think weren't any good (I think we've all known specific doctors in every specialty who just aren't good), but outside of angry venting its almost never an indictment against the specialty as a whole.

Except Functional Medicine physicians. Screw those shysters.

If they are similiar to the craniosacral manipulating osteopaths, I concur.

 

[greatnt249]

I ask him to pull out the laryngoscope and start bagging before the patient desats any further and I see a bloody Mac 3. At this point I ask RT to step aside, bag the patient back up, grab a bougie and suction and tube the patient myself, no issues.

Takes some brass ones to bloody up an airway and then complain about you being "unprofessional" for taking over.

 

[dadaddadaBATMAN]

So anecdote?
3rd year EM resident 6 months away from board eligibility calls to admit a person with new onset CHF. Mildly hypoxic, pulmonary edema, 4+ pitting edema. No diuretics given.
When asked why she didn't give lasix: "Well his bp is 110/70 and I didn't want to bottom him out."
Oblivious to the fact that afterload reduction will increase cardiac output. Also oblivious to the need for ionotropes in CHF with tenuous hemodynamics to facilitate diuresis.
20 mg IV lasix given by admitting resident and bp improved to 130/90.


Another chestnut I have.
Senior em resident calls to admit a case of diverticulitis.
Senior EM resident asks the IM resident "They're allergic to cipro, what do you think I should give?"



We all have these anecdotal stories. Painting one group with a large group is poor logic and unprofessional.

This is off topic and doesn’t belong in this thread. Feel free to start thread 999,999 about whether or not fm should be in the ed. Maybe you’ll even be the lucky number 1,000,000 and win a free iPhone.

The op asked if they should stay in this particular ed. Based on the examples given and the institutional response, the answer is a hard no.

 

[MechEDoc]

Has anyone worked in a shop where RT did airways and had issues^

Yes. Passing a tube is one thing, taking care of hemodynamics, etc is another. I worked at one place where (I believe) RT tubed a hypotensive patient without first resuscitating, etc. The patient then coded. The nurses then went through "ACLS" and got the patient "back" with a 1 mg slug of IV push epi. Not the ideal way to manage a hypotensive septic patient. But, whatever...

Places that have deskilled there entire hospital to this level suck. Even more so that the RT had to fill out a hurt feelings report.

 

[WilcoWorld]

Takes some brass ones to bloody up an airway and then complain about you being "unprofessional" for taking over.

That or a sense of entitlement...my money's on entitlement

 

[Birdstrike]

Hospital based Medicine is an absolute jungle

 

[GassYous]

The fact that we have to respond to any kind of complaint from a paraprofessional...especially about "professionalism". Sad state of affairs.

 

[EctopicFetus]

These small hospitals that are constantly allowing crappy docs to work eventually cede power and control to the paraprofessionals. They are the constant and with that they think they run the show.
leave this place. At my big Ed we had an airway nightmare. Was my partners case and he asked me to be in there. 2 upper level residents too. I have never seen or heard of an rt intubate in our Ed. It was a super tough tube and while we were working on it one of the rts was like let me get RT Jenny she is our best at intubating. Needless to say the other attending looked at me and I looked at him and between our 30+ years of experience were like no way. Note neither of us attempted the tube yet.
patient safety first and that means you need the best to intubate. That means not rt

 

[Janders]

I once worked at an ED where (apparently) all the other attendings let RT intubate, and in fact at least half of them never intubated their own patients and RT did every tube for them.

I hadn’t seen this model in training.

Set up to tube someone one of my first shifts… and RT and I are both at the head of the bed holding dueling laryngoscopes. I’m not sure which one of us was more surprised to see the other!

It was all good, he was happy to let me tube the patient. It turned out this particular RT had trained as an ENT in another country, but didn’t want to try and repeat school/residency when he immigrated to the States. Great guy, he was fun to work with…

 

[GonnaBeADoc2222]

What a clown car hospital. GTFO.

Spoiler alert for you med students / residents: Every ED has its own special insular wack-ass culture...and they all suck.

 

[Kryptocoin]

I probably won't take a job at a facility where RTs routinely intubate. Why? Because I don't want to be called for rescue airway. I have less trust in the CRNAs at my hospital ( too many horror stories), much less RTs.

 

[Siggy]

I've seen one RT intubate... and he got me out of a jam on an airway I was struggling with as a fellow.

...of course Cuban anesthesiologist working as a US RT isn't exactly your standard RT.

 

[The Knife & Gun Club]

Our community hospital does have a few RTs that intubate, mostly at night in the ICU (never in the ED). But we’re talking a cadre of like 4 RTs who had substantial additional airway training provided by CCM, and have worked there for 20+ years. I can’t imagine RELYING an RT intubate in the ED…who the hell is your backup for the failed airway? Anesthesia coming from home?

Also RT skill base is so varied - at our county shop some don’t have the cognitive capacity to recognize that wave form capno is superior to color change for tube confirmation. I’ve had multiple RTs remove my wave form peri intubation to “confirm” tube placement with the color changer. One even hid the damn wave form connector in his pocket. Even after debriefing after the intubation, they’ll just keep repeating “you must confirm colorimetric tube placement before connecting the ventilator.” I eventually gave up lol.

 

[emergentmd]

These small hospitals have very little motivation for improved care or profit. They get alot of gov money to keep the doors opened b/c they surely should have went bankrupt years ago. They don't care to make a profit, so everyone is lazy. Sounds like a government agency doesn't it?

My Bro works for the state and the things he is allowed to get away with is crazy. Talk about waste over waste. No diff with these hospitals. Too lazy to change, easier to get rid of a prn doc than find another RT live in the area.

Getting an RT likely is more difficult than money whipping a doc to come.

 

[MechEDoc]

The fact that we have to respond to any kind of complaint from a paraprofessional...especially about "professionalism". Sad state of affairs.

Nuke that guy from orbit. Board complaint, hospital complaint, etc. If you're willing to leave that job!

 

[Amazingmuzmo]

So anecdote?
3rd year EM resident 6 months away from board eligibility calls to admit a person with new onset CHF. Mildly hypoxic, pulmonary edema, 4+ pitting edema. No diuretics given.
When asked why she didn't give lasix: "Well his bp is 110/70 and I didn't want to bottom him out."
Oblivious to the fact that afterload reduction will increase cardiac output. Also oblivious to the need for ionotropes in CHF with tenuous hemodynamics to facilitate diuresis.
20 mg IV lasix given by admitting resident and bp improved to 130/90.


Another chestnut I have.
Senior em resident calls to admit a case of diverticulitis.
Senior EM resident asks the IM resident "They're allergic to cipro, what do you think I should give?"



We all have these anecdotal stories. Painting one group with a large group is poor logic and unprofessional.

Sounds like those residents need to be taught better. Doesn’t excuse the substandard care given by those not trained in EM.

 

[Angry Birds]

So anecdote?
3rd year EM resident 6 months away from board eligibility calls to admit a person with new onset CHF. Mildly hypoxic, pulmonary edema, 4+ pitting edema. No diuretics given.
When asked why she didn't give lasix: "Well his bp is 110/70 and I didn't want to bottom him out."
Oblivious to the fact that afterload reduction will increase cardiac output. Also oblivious to the need for ionotropes in CHF with tenuous hemodynamics to facilitate diuresis.
20 mg IV lasix given by admitting resident and bp improved to 130/90.


Another chestnut I have.
Senior em resident calls to admit a case of diverticulitis.
Senior EM resident asks the IM resident "They're allergic to cipro, what do you think I should give?"



We all have these anecdotal stories. Painting one group with a large group is poor logic and unprofessional.

Lasix 20 mg IV?
Why give such a high dose? Start with 2 mg and titrate your way up.

EDIT: I'm obviously kidding. I've never given 20 mg of Lasix IV. Such a low dose. Is there some logic to this? I might be unaware of it and simply ignorant here. I always hit em with 40-80 mg IV at least.

 

[alpinism]

So anecdote?
3rd year EM resident 6 months away from board eligibility calls to admit a person with new onset CHF. Mildly hypoxic, pulmonary edema, 4+ pitting edema. No diuretics given.
When asked why she didn't give lasix: "Well his bp is 110/70 and I didn't want to bottom him out."
Oblivious to the fact that afterload reduction will increase cardiac output. Also oblivious to the need for ionotropes in CHF with tenuous hemodynamics to facilitate diuresis.
20 mg IV lasix given by admitting resident and bp improved to 130/90.


Another chestnut I have.
Senior em resident calls to admit a case of diverticulitis.
Senior EM resident asks the IM resident "They're allergic to cipro, what do you think I should give?"



We all have these anecdotal stories. Painting one group with a large group is poor logic and unprofessional.

Sounds like a solid EM resident who's been keeping up with the EM literature.

Most recent studies have shown that lasix is harmful in acute heart failure.

 

[greatnt249]

Sounds like a solid EM resident who's been keeping up with the EM literature.

Most recent studies have shown that lasix is harmful in acute heart failure.

I'm going to have to ask you to elaborate on this a little further, unless I missed some sort of intended sarcasm.

 

[alpinism]

I'm going to have to ask you to elaborate on this a little further, unless I missed some sort of intended sarcasm.

Link with the relevant studies: http://www.emdocs.net/furosemide

 

[MechEDoc]

Link with the relevant studies: http://www.emdocs.net/furosemide

I'm sort of aware of this argument, but I have been unclear as to when diuretics should be given (in an EBM setting)? Also, I feel like this is similar to Kayexalate. If you have pulmonary edema, the hospitalist will give diuretics and usually demand that they are given prior to admission. It seems like an uphill battle.

Thoughts?

 

[greatnt249]

Link with the relevant studies: http://www.emdocs.net/furosemide

Sorry, I must have missed the day in statistical analysis class where case reports were equivalent to "current literature." Also not sure how the link relates at all to the clinical presentation described where it was explicitly mentioned that the patient had not only pulmonary edema but "4+ pitting edema"; the patient was clearly volume overloaded in that case. If your contention is that BiPAP and afterload reduction aren't utilized more, well, I can't argue with you there based on my experience. The conclusion that diuretics are actually harmful when a) the patient in question in the above scenario is not what is being described (ie pulmonary edema without overt volume overload), and b) the studies that make said assertion were either small or didn't actually describe clinical outcomes is spurious at best. And c), when was 2014 considered "current" in today's world?