First, Tom Dibble is the old guy who has a subarachnoid hemorrhage. This occurs because of an aneurysm, which is a small outpouching of a blood vessel in the brain's circulation, burst and spilled blood around the surface of the brain. It can happen to people of any age and is survivable. However, in his case, he has a fairly large bleed and it has caused edema, or swelling of the frontal lobes of the brain. They're giving him medications and other maneuvers to try to decrease the swelling, but these measures usually do not work when the bleed is large. Anna does the thing no resident should do--promise, or just as good as promise, some surgery to try and produce a miracle. She's the ER intern, and is overstepping her field of expertise. She seemed to know nothing about neurosurgery except what she was just told when talking to the son about the prognosis.

The 6 year old boy with seizure was given print developer and insecticide. The treatment for insecticide poisoning is supportive, and Atropine, if needed, and he was given that when his heart rate was low. The others thing given as treatment were inhaled Amyl nitrate, sodium nitrate, and sodium thiosulfate. From these meds, I figured the print developer contained cyanide (if it was mentioned on screen, I didn't hear it, even on video). These bind to cyanide and help get it out of the system.

You noticed that they were giving narcan to a number of patients. It is a narcotic antagonist--it blocks the effects of all narcotics, so may be useful in the heroin OD's and it is also given to all people found unconscious or with altered mental status as a test for narcotic effects.

Next, I'm thinking that Doug research shows the benefits of using PCA, or patient controlled anesthesia, in kids. PCA's have been used in adults for quite a while. What it does is allow patients to control how much pain medication they give themselves. It is a pump where a baseline dose of narcotic might be given every hour (sometimes this is omitted), and that is supplemented by a push of a button which delivers more narcotic. There's a lock out time and maximum dose that can be given to avoid overdose. As seen in the episode, there is still an old school that believes that people should try to tough out pain, and that's unnecessary. Others are afraid of turning people into addicts, though research shows that few people become addicts to pain killers in the absence of other addictive behavior (e.g., alcohol or previous narcotic abuse) in the past.

What Kerry is critical of is Doug's "randomization of the control group," When doing research trials, there is a treatment group and a control group. You need to make them as similar as possible. If they're not, someone could look at the article and say that since the groups weren't similar, there may be something else in the treatment group that made the treatment do better instead of the treatment itself. That is why Kerry talked about some "bias" in the study.