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Updates in High dose Insulin and Euglycemia Therapy (HIET) for the treatment of Beta-adrenergic Receptor and Calcium Channel Antagonists Overdose

Core EM

HIET improves contractility without increasing SVR, while vasopressin and epinephrine transiently increase SVR/MAP but worsen cardiac output in anesthetized dogs given propranolol (Holger 2007). Disposition to ICU. Insulin versus vasopressin and epinephrine to treat β-blocker toxicity. J Med Toxicol. 2020;16(2):212-221.

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Hypothermic Cardiac Arrest: Pearls and Pitfalls

EMDocs

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. Resuscitation 2018.

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Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 JAMA 2018; 319:1889. Crit Care 2018; 22:131. Increases coronary blood flow.

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

AAEM RSA

The 48-hour group had a significantly longer length of stay in the ICU and time on mechanical ventilation amongst survivors, both of which were expected since they were kept at target temperature for longer, requiring more resources. The trial was conducted in 25 ICUs in France between 2014 and 2018. C to a goal of 36.5

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Could you have prevented this young man's cardiac arrest?

Dr. Smith's ECG Blog

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. They achieved ROSC and wanted to transfer to our institution for post-arrest care. After ROSC achieved: Sinus rhythm.

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A middle aged man with unwitnessed cardiac arrest

Dr. Smith's ECG Blog

Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose. He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. In 2018 there is generally a delay to onset of dialysis in most EDs.

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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

REBEL EM

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

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