Detective Work

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In investigating many types of crimes, the police have an adage,

“Follow the money.”

Money is a grat motivator, it motivates some people to work hard, some to commit crimes, others to compromise their principles.

Rogue Medic has been riding his “Epinephrine is Bad” hobby horse lately. He’s been citing studies from the 1990s to prove that we shouldn’t be giving Epinephrine to cardiac arrest patients. He suggests, or maybe demands, studies of Epinephrine to guide us into the future. Sounds good, in theory at least.

Epinephrine has been around for a long time, much longer than he or I have been in EMS. It’s also cheap and plentiful. It’s also naturally occuring in the human body so logic, if not science, say that giving it to a heart that has stopped should help. Maybe it does, maybe it doesn’t.

That’s where the adage I quoted at the top of this post comes into play.

No one is going to fund a study of Epinephrine because almost nobody stands to benefit from it. Well, except for the manufacturers of Vasopressin. Who would love a study that shows that Epinephrine is harmful, while Vasopressin isn’t.

Chances are that neither one will help, because as one of his commenters pointed out, patients in Asystole are probably beyond help absent specific circumstances.

Of course it’s hard to prove that Epinephrine causes death because patients in cardiac arrest are by definition dead. Sometimes we get (and they) get lucky and we can bring them back to life, but for the most part they stay dead, even those in Ventricular Fibrillation.

Since hypoxia is proven to be bad for the brain, I’m not going to hold my breath waiting for the multi-center, large number of patients, study that RM so desires.