The Skeptics' Guide to EM

SEPTEMBER 23, 2017

[display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. September 2017. display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. September 2017. Prehospital advanced cardiac life support for out-of-hospital cardiac arrest: a cohort study. Academic Emergency Medicine. vs. 66.8%, p=0.73).

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

EMDocs

APRIL 10, 2024

1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] If epinephrine is used, small initial doses ( <1 ug/kg) are preferred. mL/kg/min. [2]

E-9-1-1 92

E-9-1-1 Plasma Epinephrine Life Support 92

REBEL EM

NOVEMBER 6, 2023

to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5) This dysregulation of vasodilation is associated with a mortality of close to 25%.

ICU 72

ICU Epinephrine ALS OR 72

NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. The AHA further specifies that IV access is the preferred route; however, IO access is acceptable if unable to obtain IV access. [2] Or in other words, is IO access inferior to IV access?

E-9-1-1 52

E-9-1-1 Advanced Life Support Epinephrine Life Support 52

REBEL EM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

ICU 145

ICU ALS Epinephrine OR 145

ECG & Echo Learning

OCTOBER 2, 2022

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? Most agents exhibit both vasopressor and inotropic effects (Figure 1). Minimal chronotropic effect.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ). An Impella device was placed to maintain cardiac output and perfusion pressures.

Defibrillator 113

Defibrillator Coronary ALS STEMI 113

REBEL EM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Article: Kumar M et al. Significant coagulopathy: INR > 1.8

FFP 52

FFP E-9-1-1 ICU ALS 52

ACEP Now

NOVEMBER 14, 2023

The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient. 2 Death from hemoptysis is akin to drowning, so airway considerations usually take precedence over hemodynamic considerations.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52

REBEL EM

JANUARY 23, 2023

antibiotics, NSAIDs) Acute urticaria with angioedema or anaphylaxis provided that urticaria was still present after initial treatment and alleviation of anaphylaxis symptoms. Exclusion: Presented with acute anaphylaxis, and their acute anaphylactic symptoms had not yet been treated. The mean time spent at a treatment center in hours was 1.7

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

ECG & Echo Learning

JANUARY 18, 2023

I C Blood samples Management Recommendation Level of evidence Serum biomarkers of myocardial infarction ( troponin ) should be sampled as early as possible without delaying reperfusion therapy. I C Symptom relief Symptom Management Recommendation Level of evidence Hypoxia Oxygen is indicated if SaO2 < 90% or PaO2 < 60 mmHg.

STEMI 40

STEMI Coronary OR Defibrillator 40

The Skeptics' Guide to EM

JUNE 24, 2017

[display_podcast] Date: June 20th, 2017 Reference: Bernard et al. display_podcast] Date: June 20th, 2017 Reference: Bernard et al. 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. Circulation 2016.

CPR 100

CPR Epinephrine ALS Paramedic 100

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 6 In one study, almost all patients who went on to develop seizures had tachycardia prior to the seizure. EMIT II immunoassay).

Overdose 65

Overdose E-9-1-1 ALS Emergency Department 65