Ironically, this seems to reflect more of an old-fashioned “keeping up with the times” mentality, with a general premise of breaking away from perceived dogma. As to specifically what these “times” are that seem to be passing the rest of us by, and what has become problematically dogmatic in training, I admit I have been unable to locate in any of the proposals other than the broader, “timely” rubric of change for change’s sake.
Rather than snow him with benzos, I suggested metoprolol, a lipophilic beta-1 blocker with both peripheral and central nervous system effects. Her response to this was, “Oh no, you can’t do that – what about unopposed-alpha stimulation?” It was at this point I realized the level of misinformation regarding this dogma had become so pervasive, that newly-minted physicians were applying it as an absolute contraindication to beta-blocker treatment for all stimulants.
Administration of intravenous calcium has traditionally been considered a contra-indication for the treatment of hyperkalemia in the presence of digoxin toxicity.
Cricoid pressure is a time-honored maneuver based in decades of dogma, but had never been tested in randomized trials.
If you are like me you have been trained to not use epinephrine in digital nerve blocks. As a matter of fact I was taught NEVER to use epinephrine for regional nerve blocks involving the, “fingers, ears, toes, nose, and hose.” The fear is that the use of epinephrine will cause vasoconstriction and ultimately cause necrosis of tissue distally, due to the lack of collateral blood flow. This belief has been passed down from generation to generation of medical providers and quite honestly been accepted most likely because it makes physiological sense, but needs to be seriously challenged. Using epinephrine in digital nerve blocks may benefit patients by speeding up onset and helping prolong the effect of anesthesia.
Concerns that too little antibiotics could lead to the survival or “selection” of resistant bacteria can be traced back to the discovery of antibiotics. However, there is a lack of evidence to show that failing to complete a course of antibiotics leads to resistance in that bacteria.
Taking it did not lower their risks of cardiovascular disease, dementia or disability. And it increased the risk of significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital.
Withholding administration of narcotic analgesia in patients with acute abdominal pain for fear of masking pathology is still pervasive in current medical practice. We reviewed all the prospective trials that investigated the safety, adverse affects, and ultimate outcome in patients with acute abdominal pain receiving narcotic analgesia within the emergency department (ED). No adverse outcomes or delays in diagnosis could be attributed to the administration of analgesia. Based on this research, we propose that it is safe and humane to administer narcotic pain relief to patients presenting to the ED with acute abdominal pain provided no contraindications exist.
The use of physostigmine had virtually disappeared by the 1990s, and the Association of United States Poison Centers reported in 1997 that only two percent of more than 7,000 patients treated that year for anticholinergic toxicity received physostigmine. What happened?
First off, the clinical abandonment of physostigmine was somewhat surprising because it is one of the most effective and specific antidotes.
The goal of this article is to illustrate the many deficiencies of administering NS in a trauma patient, and to encourage critical thinking regarding current fluid resuscitation strategies that discuss increasing support for the use of blood components, including whole blood (WB).
The rationale behind ordering banana bags for these patients is relatively simple–alcoholics are likely to have nutritional deficiencies related to their dietary preferences for alcohol over nutrient-dense foods, putting them at risk for complications. Furthermore, the administration of fluids is conventionally believed to help speed up sobriety. But it seems the combination of these components may be unnecessary, let’s break it down piece by piece:
The medical fraternity must learn how to ask questions systematically, how to find the answers in literature, how to critically appraise the literature, and how to eventually apply the results to practice. Only when clinicians rise above the mundane, think out of the box, and come up with new ideas, will science progress. After all, nobody gets a Nobel Prize for maintaining status quo!
Hence, do not let sleeping dogmas lie, kick them and drive them out!
Dogma is a belief generally held to be true by a group, organisation or professional body that is put forth as authoritative without adequate grounds.