Thoracic epidurals

OldManDave

Fossil Bouncer Emeritus
Moderator Emeritus
10+ Year Member
Feb 26, 1999
1,768
4
55
Lafayette, IN
www.oldpremeds.org
  1. Attending Physician
    militarymd said:
    I hear this all the time from residents, "don't let the evidence confuse me, based on my experience, I know what to do."
    That is not what that phrase implies. As someone with a mere 19 or so months of experience, I am not so brash as to proffer the assertion you have made. My statement applies to medicine, including clinical medicine, as a whole. Face it - much of what is taught in med school is still based upon prokaryotes & eukaryotes - not on organ systems as complex as a hominid.

    Please take a moment to actually read my post before you decide to make slighting comments based upon it.
     

    militarymd

    SDN Angel
    10+ Year Member
    15+ Year Member
    Dec 17, 2003
    5,886
    20
    1. Attending Physician
      No one will argue that thoracic epidurals will give you superior pain relief. You don't need a study to know it. A simple observer can see it.

      Good pain relief alone can be the only indication needed to give someone a thoracic epidural.

      I start having problems when you start telling people that this neuroaxial technique can do things that it cannot do....based on evidence.

      Based on at least 2 studies that I know of....atelectasis...as graded by a chest CT, there is no improvement in the group of patients with the neuroaxial block and who have better pain control.
       

      militarymd

      SDN Angel
      10+ Year Member
      15+ Year Member
      Dec 17, 2003
      5,886
      20
      1. Attending Physician
        OldManDave said:
        Please take a moment to actually read my post before you decide to make slighting comments based upon it.

        What's slighting about what I said?

        I'm simply point out that MANY clinicans out there don't like having evidence complicate their practice....which doesn't change....I have met WAY too many anesthesiologists who, the second after they finish, residency...and many who at the CA2 level has decided that they know it all.

        The practice of medicine continuously changes.......based on new evidence that comes out every day/week/month.

        If you wait until there is irrefutable proof before you abandon old practices, then you will always be a day late and a dollar short.

        As I've said, if you're putting epidurals in for pain relief then fine, but if you're putting them in thinking that you are preventing atelectasis, then I think you are passing bad information to someone.
         
        About the Ads

        jetproppilot

        Turboprop Driver
        15+ Year Member
        Mar 12, 2005
        5,863
        135
        level at FL210
          militarymd said:
          What's slighting about what I said?

          I'm simply point out that MANY clinicans out there don't like having evidence complicate their practice....which doesn't change....I have met WAY too many anesthesiologists who, the second after they finish, residency...and many who at the CA2 level has decided that they know it all.

          The practice of medicine continuously changes.......based on new evidence that comes out every day/week/month.

          If you wait until there is irrefutable proof before you abandon old practices, then you will always be a day late and a dollar short.

          As I've said, if you're putting epidurals in for pain relief then fine, but if you're putting them in thinking that you are preventing atelectasis, then I think you are passing bad information to someone.

          cant argue with that.
           

          OldManDave

          Fossil Bouncer Emeritus
          Moderator Emeritus
          10+ Year Member
          Feb 26, 1999
          1,768
          4
          55
          Lafayette, IN
          www.oldpremeds.org
          1. Attending Physician
            MilMD,

            Maybe it was me that misinterpreted the meaning of your statement. I, apparently erroneously, thought you were implying that as a CA-2 resident that I did not use evidence & based decisions on my immense (sarcasm intended) experential base. Now, after practicing what I was preaching - read your post from a different perspective & completely agree with your point & the point you made above.

            My apologies - I was the one who was in error.
             

            militarymd

            SDN Angel
            10+ Year Member
            15+ Year Member
            Dec 17, 2003
            5,886
            20
            1. Attending Physician
              OldManDave said:
              MilMD,

              Maybe it was me that misinterpreted the meaning of your statement. I, apparently erroneously, thought you were implying that as a CA-2 resident that I did not use evidence & based decisions on my immense (sarcasm intended) experential base. Now, after practicing what I was preaching - read your post from a different perspective & completely agree with your point & the point you made above.

              My apologies - I was the one who was in error.

              :thumbup:
               
              About the Ads
              This thread is more than 15 years old.

              Your message may be considered spam for the following reasons:

              1. Your new thread title is very short, and likely is unhelpful.
              2. Your reply is very short and likely does not add anything to the thread.
              3. Your reply is very long and likely does not add anything to the thread.
              4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
              5. Your message is mostly quotes or spoilers.
              6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
              7. This thread is locked.