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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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REBEL Core Cast 108.0 – Angioedema

REBEL EM

Both conditions can range in severity from benign to life threatening (Wilkerson 2012). 2012; 14(11). Hereditary Angioedema (presents in childhood) and Acquired C1 Inhibitor Deficiency (adulthood) Both involve abnormalities in the level or function of the C1 inhibitor. J Allergy Clin Immune Tract 2017; 5(5): 1402-9. EBMedicine.net.

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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.

E-9-1-1 269
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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.

E-9-1-1 286
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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).

ALS 105
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Transfusion Reactions

Core EM

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

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Transfusion Reactions

Core EM

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1