Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Sutures for Skin Tears, Oxygen Therapy for STEMI Patients, and Blood Alcohol Levels to Assess Intoxication: More Myths in Emergency Medicine

By Kevin M. Klauer, DO, EJD, FACEP | on January 20, 2015 | 2 Comments
CME CME Now Myths in EM
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version
Sutures for Skin Tears, Oxygen Therapy for STEMI Patients, and Blood Alcohol Levels to Assess Intoxication: More Myths in Emergency Medicine

In 2012, Cornet et al published an excellent systematic review on oxygen administration in emergencies.7 They concluded that the outcomes in many disease entities are worsened by supplemental oxygen administration. Many conditions are worsened by the use of supplemental oxygen in patients without hypoxia: these include AMI, congestive heart failure, chronic obstructive pulmonary disease, and stroke.

You Might Also Like
  • Routine Oxygen Therapy Unnecessary with Suspected Heart Attack
  • Superficial Venous Thromboses, Intracranial Aneurysms, and Treating High Glucose Levels: More Myths in Emergency Medicine
  • Emergency Physicians Should Know Risks Entailed in Discharging Patients with Pending Blood Cultures
Explore This Issue
ACEP Now: Vol 34 – No 01– January 2015
Figure 2. For my modification, I cut pieces of Steri-Strips for anchoring at key locations and sutured through them. Note that tissue loss and defect and significant tension did not allow for approximation of all wound edges.

Figure 2. For my modification, I cut pieces of Steri-Strips for anchoring at key locations and sutured through them. Note that tissue loss and defect and significant tension did not allow for approximation of all wound edges.

Now, back to AVOID (Air Versus Oxygen In ST-elevation MyocarDial Infarction). Perhaps this is the trial that the Cochrane crew was looking for. In it, 638 patients with suspected STEMI (441 confirmed) were randomized to no oxygen (unless SaO2 <94%) or 8 L/min via simple face mask. The primary end point was infarct size (good choice), but the measure of infarct size was total creatine phosphokinase (CPK) and troponin I (surrogate markers). Biomarkers do predict AMI, but their ability to accurately predict infarct size has been challenged.8 A redeeming feature of the study was the confirmation of increased myocardial damage at six months via cardiac MRI.

Other limitations include the use of 8 L/min oxygen for the treatment group. In general, 2–4 L/minute via cannula is more consistent with current U.S. practice. Finally, we have to recognize the limitation of pulse oximetry. Using pulse oximetry to estimate actual arterial oxygen tensions (I’m not suggesting the use of arterial blood gases) is akin to using bifocals to pick up a grain of salt. For instance, a pulse oximetry range between 92 percent and 96 percent will likely have a much larger range of arterial oxygen tension associated with it. The vasoactive effect that oxygen has on chemoreceptors is a microscopic phenomenon.

Despite the fact this study, and many before it, have had limitations, we have forgotten one thing—common sense. I think we can stop studying this concept. Although perhaps the scientist in all of us longs for that one definitive study, we are victims of paralysis by analysis. We have enough evidence to conclude that giving this drug to people without a demonstrated need (eg, hypoxia) provides them no benefit and may, in fact, cause harm.

Oxygen is a vasoactive drug. This is an indisputable fact. Give this drug to patients who don’t need it, and whether you can prove it with scientific rigor or not, you will eventually hurt people.

Alcohol Levels: What Question Are You Asking?

Some tests have their utility stretched beyond rational use. Blood alcohol levels are frequently ordered but have limited clinical value, and such ordering patterns are validated and encouraged with positive results. I think we have collectively forgotten what questions we need to ask and what the right test(s) is to find those answers. Alcohol levels may be important when we are determining the source of an altered mental status, but when the source is clear, why order it? For instance, a negative ethanol level in a patient with minor head trauma should point the diagnostic compass immediately toward intracranial injury, but when patients say they drank a six-pack, you can smell it, and they appear intoxicated, does your laboratory really need to confirm the presence of alcohol? If confirmation is warranted, why not a breathalyzer? If you say you’re drunk, your breath says you’re drunk, and I think you’re drunk, you’re drunk.

Pages: 1 2 3 4 5 | Single Page

Topics: CMECritical CareEmergency DepartmentEmergency MedicineEmergency PhysicianProcedures and SkillsTrauma and Injury

Related

  • Push-Dose Pressors in the Emergency Department

    June 29, 2025 - 1 Comment
  • 10 Essentials for Your Emergency Department Fanny Pack

    June 17, 2025 - 0 Comment
  • EM Runs in the Family

    February 26, 2025 - 0 Comment

Current Issue

ACEP Now: July 2025

Download PDF

Read More

About the Author

Kevin M. Klauer, DO, EJD, FACEP

Kevin M. Klauer, DO, EJD, FACEP, is Chief Medical Officer–hospital-based services and Chief Risk Officer for TeamHealth as well as the Executive Director of the TeamHealth Patient Safety Organization. He is a clinical assistant professor at the University of Tennessee and Michigan State University College of Osteopathic Medicine. Dr. Klauer served as editor-in-chief for Emergency Physicians Monthly publication for five years and is the co-author of two risk management books: Emergency Medicine Bouncebacks: Medical and Legal and Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals. Dr. Klauer also serves on the ACEP Board.

View this author's posts »

2 Responses to “Sutures for Skin Tears, Oxygen Therapy for STEMI Patients, and Blood Alcohol Levels to Assess Intoxication: More Myths in Emergency Medicine”

  1. February 8, 2015

    Derek McCalmont Reply

    Dr. Klauer incorrectly states that the level of blood alcohol for legal intoxication varies from state to state. Laws and penalties vary but the level of .08 is universal across all 50 states.

    At what point does Dr. Klauer propose discharge for intoxicated patients without family or friends to assume care in the absence of a blood alcohol level?

  2. February 19, 2015

    suture through Steri-strips | DAILYEM Reply

    […] ACEP Now article + pictures; original 2011 article for idea […]

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603