ACEP Now

JULY 7, 2023

2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. 5 More recent literature defines “refractory” as VT or VF that is persistent or recurrent despite three shocks from a defibrillator, three rounds of epinephrine, and use of an antiarrhythmic (i.e.,

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

The Skeptics' Guide to EM

APRIL 20, 2019

Date: April 17th, 2019 Reference: Little et al. Date: April 17th, 2019 Reference: Little et al. To get the crowd warmed up for our nerdy structured critical appraisal we reviewed a paper by Dr. Esther Choo et al. Major trauma: Does weekend attendance increase 30-day mortality? Theme music is an important part of the SGEM.

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Epinephrine ALS Emergency Department EMS 100

Don't Forget the Bubbles

DECEMBER 25, 2023

Disease-Oriented Outcomes (DOOs) The PARAMEDIC-2 trial looked at the effectiveness of epinephrine in adult patients who suffered an out-of-hospital cardiac arrest. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% doi:10.1136/bmjebm-2018-110891 Perkins GD, Ji C, Deakin CD, et al.

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Epinephrine ALS OR Paramedic 83

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al.

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Defibrillator CPR Epinephrine Life Support 85

ECG & Echo Learning

OCTOBER 2, 2022

Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 References Overgaard, Dzavik et al. Jentzer et al. Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Gattinoni L, Brazzi L, Pelosi P, et al. Circulation 2011.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

JULY 18, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds.

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E-9-1-1 Epinephrine ED ALS 52

REBEL EM

JANUARY 23, 2023

Second-generation H1 antihistamines (cetirizine, loratadine, and fexofenadine) do not cross the blood-brain barrier as easily (Bernstein J 2018). Article: Abella BS et al. Philadelphia: Wolters Kluwer Health; 2018. Zuberbier, Torsten, et al. Bernstein J, Leslie T. Antihistamines. In: Grammer LC, Greenberger PA, editors.

Allergic Reaction 52

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

REBEL EM

SEPTEMBER 26, 2022

Article: Kumar M et al. It’s unclear whether interventions such as cauterization, clip placement, epinephrine injection, etc., References De Pietri L, Bianchini M, Montalti R, et al. PMID: 31229583 Kumar M, Ahmad J, Maiwall R, et al. PMID: 31148204 Rout G, Shalimar, Gunjan D, et al. Hepatology. 2020;71(1):235-246.

FFP 52

FFP E-9-1-1 ICU ALS 52

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard H, Soreide E, de Haas, I et al. Kirkegaard et al. De Fazio C, Skrifvars MB, Soreide E et al. The trial was conducted in 25 ICUs in France between 2014 and 2018. New Engl J Med. 2013;369(23):2197–2206.

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E-9-1-1 CPR ICU ALS 52

FOAMfrat

OCTOBER 20, 2023

And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. Sackles et al. 2018 Apr;46(4):532-539. De Jong A, Molinari N, Terzi, et al. Hypes C, Sakles J, Joshi R, et al.

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E-9-1-1 ALS ACS OR 52

ECG & Echo Learning

JANUARY 18, 2023

positive chronotropic medication (epinephrine, vasopressin, and/or atropine) is indicated – temporary pacing is indicated in cases of failure to respond to positive chronotropic medication – urgent angiography is indicated if the patient has not received previous reperfusion therapy.

STEMI 40

STEMI Coronary OR Defibrillator 40

FOAMfrat

SEPTEMBER 19, 2024

These side effects do not contraindicate antivenom administration and can be treated with antihistamines and epinephrine. Hypotension and anaphylaxis should be treated with epinephrine following your local guidelines. 2018, foamed.ebmedicine.net/podcast/episode-20-emergency-department-management-of-north-american-snake-envenomations/.

Emergency Department 95

Emergency Department Epinephrine OR Plasma 95

The Skeptics' Guide to EM

MARCH 5, 2022

Date: February 24th, 2022 Reference: Parish et al. Date: February 24th, 2022 Reference: Parish et al. Tricoci et al. The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. Background: There are many things in medicine that could be considered myth or dogma.

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Epinephrine ALS OR 100

EMDocs

JANUARY 20, 2024

Rosh Review Website Link Further Reading Further FOAMed: [link] [link] References: Ahmad SA, Brito D, Khalid N, et al. doi:10.25122/jml-2018-0067 Takotsubo syndrome. doi:[link] Kosuge M, Ebina T, Hibi K, et al. 2006.105.2.264 Templin C, Ghadri JR, Diekmann J, et al. doi:[link] Citro R, Bossone E, Parodi G, et al.

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E-9-1-1 EMS Coronary ACS 74

Don't Forget the Bubbles

DECEMBER 5, 2023

Nizami T, Beaudoin F, Suner S, et al. The study included all children born between January 1, 2010, and December 31, 2018, who received a treatment for gastroesophageal reflux disease or other gastric acid–related disorders, namely PPIs, histamine 2 receptor antagonists, or antacids/alginate. Crocker, B.C.S.,

Coronary 111

Coronary Epinephrine CPR Emergency Department 111

REBEL EM

DECEMBER 19, 2022

REBEL Cast Ep113 – Defibrillation Strategies for Refractory Ventricular Fibrillation Click here for Direct Download of the Podcast Paper: Cheskes S, et al. REFERENCES: Cheskes S, et al. 2022 Nov 6 PMID: 36342151 Cheskes S, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. N Engl J Med.

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Defibrillator Paramedic CPR EMS 52

EMDocs

OCTOBER 29, 2024

doi:10.1016/S0033-0620(05)80036-2 Balik M, Novotny A, Suk D, et al. doi:10.3390/JCM13185344 Yamagishi T, Tanabe T, Fujita H, et al. EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. doi:10.1136/BCR-2018-225879 Dawood S, Hill A, Al Rawi O. Anaesth Intensive Care. J Clin Med.

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E-9-1-1 ICU Epinephrine EMS 87