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SGEM#238: The Epi Don’t Work for OHCA

The Skeptics' Guide to EM

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. An oral airway is placed, peripheral intravenous (IV) line started successfully and the paramedic asks her partner if you want to administer IV epinephrine? JAMA 2012 and Cournoyer et al.

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Post-Tonsillectomy Hemorrhage: ReBaked Morsel

Pediatric EM Morsels

Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage. Don’t await for fancy meds to arrive from pharmacy. Load gauze onto Magill forceps.

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The Broselow-Luten System

Pediatric EM Morsels

Rosenburg 2010] B-L system is designed for 12yo and younger, patients up to 80 lbs, height 46-143 cm [Meguerdichian 2012] Estimates the 50%ile weight for height (Length vs Ideal Body Weight). Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight.

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Don’t Forget About the IO in the Critically Ill Patient

REBEL EM

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. 2012 PMID: 21893125. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

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SGEM#183: Don’t RINSE, Don’t Repeat

The Skeptics' Guide to EM

They continue CPR, get intravenous access, give a round of epinephrine and then wonder if they should start rapid cooling en-route to the hospital with some cold saline. The Cochrane Collaboration updated their review on hypothermia for neuroprotection in adults after CPR in 2012. By-standard CPR is started and EMS is called.

CPR 100
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IV versus IO: Does your Site of Access Matter in Cardiac Arrest?

NAEMSP

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. Time to epinephrine in out-of-hospital cardiac arrest: A retrospective analysis of intraosseous versus intravenous access. 2012 Jan;83(1):107-12. minutes versus 5.4 minutes). [5]

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Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Intensive Care Med 2012; 38:9. Increases coronary blood flow. mg/kg) IM: (1:1000): 0.1

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