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Neurogenic Shock in Children

Pediatric EM Morsels

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Both norepinephrine and epinephrine can be used. 2011;46(9):1771. 5 th Edition. J Pediatr Surg.

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The Broselow-Luten System

Pediatric EM Morsels

Most emergency drugs except for amiodarone and succinylcholine are based on ideal body weight [Emergency Medical Services for Children, Luten 2007] Epinephrine, dopamine, fentanyl, ketamine based on what child should weigh. 2007-2902 Wells M, Coovadia A, Kramer E, Goldstein L. 2020;13(1):9. 2016;23(1):21-28.

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ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

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IV versus IO: Does your Site of Access Matter in Cardiac Arrest?

NAEMSP

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. 1] Table from Hamam et al. 9] Figure from Clemency et al. 1] References 1. minutes versus 5.4 minutes). [5] vs 19.7%) access (figure below).

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Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Here they are: Learning Points: 1. Type 1 and 2 Myocardial Infarction and Myocardial Injury: Clinical Transition to High-Sensitivity Cardiac Troponin I. Am J Med [Internet] 2017;130(12):1431–9.e4.

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Cetirizine Vs Diphenhydramine For the Treatment of Acute Urticaria in the ED

REBEL EM

Moreover, the FDA approved intravenous (IV) cetirizine to treat acute urticaria in 2019. Patients were randomized in a 1:1 ratio. However, according to the American Academy of Allergy, Asthma, and Immunology, “oral antihistamine therapy is equivalent to IV therapy” (Ledford D 2019). 2005 Sep;116(3):643-9.

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Optimizing Hemodynamics Prior to RSI

FOAMfrat

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Recommendations : 1. Why is Physiologic Optimization Important?

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