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Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 J Cardiovasc Pharmacol Therap (2014).

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Resident Journal Review: Available Evidence Regarding Targeted Temperature Management (TTM)

AAEM RSA

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):19.

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Calcium in Out-of-Hospital Cardiac Arrest

NAEMSP

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. However, evidence emerged in the 1980’s demonstrating that calcium chloride had no effect on return of spontaneous circulation (ROSC) rates, and in fact could be detrimental (Landry, Foran, & Koyfman, 2014).

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Classic Journal Club: TXA for Epistaxis

REBEL EM

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. 2013 Sep;31(9):1389-92. PMID: 33612282 Janapala RN, Tran QK, Patel J, Mehta E, Pourmand A. Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al.

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What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

ACEP Now

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. 1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). 2018;13(9):e0204169. Circulation.

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Sepsis Updates Relevant to the Emergency Physician

EMDocs

This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). 1 Since 2021, attempts to identify a single screening tool with optimal sensitivity and specificity to predict which patients will develop sepsis or septic shock have been ongoing.

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