Cite this post as:
Rory Spiegel. EM Nerd-The Case of the Man Made of Straw Continues. EMCrit Blog. Published on November 11, 2017. Accessed on January 19th 2022. Available at [https://emcrit.org/emcrit/em-nerd-case-man-made-straw-continues/ ].
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rory
it is very disheartening that in the year 2017 JAMA would print such malarkey.
i suspect it is because of the current crisis, and national focus, and that this “study” seems to provides fuel for the argument that” those silly ER docs are pumping the nation with narcs”.
As you say, we need good studies to help steer us toward appropriate care (like the work that Sergey Motov is doing at Maimonides, and the folk at st joe’s in patterson,nj). what we dont need is fluff.
thank you
tom
A better study would be to have EMS give either 1g of IV acetaminophen, or 0.1mg/kg of IV morphine, or 1mcg/kg of IV fentanyl, and make it a double-blinded study.
As an emergency physician, the #1 pain control for extremity pain is splinting / casting / supporting. I would argue that no analgesia would have had the same effect if splinting / casting / supporting was done. Useless conclude anything else from this. My 2 cents.
The study isn’t equitable. Should have started with a baseline of 1g of acetaminophen/ paracetamol in all Pt’s and then compared the addition of 400mg of Brufen or a small dose of opiate. 300mg of acetaminophen is a sub therapeutic dose so the two arms aren’t comparable?
Thanks Rory.
The other thing to point out here is that in the real world we don’t blind our patients when giving the analgesia. When we hand them the two white paracetamols, or the two pink ibuprofens, most patients will quite reasonably ask, “what are you giving me?”. When they hear ‘paracetamol’ or ‘ibuprofen’ I would suggest that that triggers a cognitive bias in them (a kind of reverse placebo effect) if their pain is significant. Conversely, when we hand them the liquid morphine and they ask what’s in the cup, it may have the opposite effect