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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

Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Beta-adrenergic receptor antagonists (Beta blockers, BB) and calcium channel antagonists (calcium channel blockers) are common drugs that can produce profound cardiac depression and shock when taken in overdose.

Overdose 246
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emDOCs Podcast – Episode 93: BRASH Syndrome

EMDocs

2020 Aug;59(2):216-223. Remember to treat all components of the disease, including the underlying cause, once identified. References: Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. doi: 10.1016/j.jemermed.2020.05.001. 2020.05.001.

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The Broselow-Luten System

Pediatric EM Morsels

DeBoer 2020] Now seen as industry standard in pediatric emergency care. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. K 2020] In Mexican children, the Broselow differed from actual weight by <10% in 46-64% of patients. Published 2020 Feb 12.

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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. 2020) thus lending itself to a potential drug for cardiac arrest. 2020), but IV Calcium is still used routinely in some cases in the critical care setting, such as congenital heart disease. References: 1. Ramazan, K.,

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

Epinephrine infusion was begun. These are also the most commonly reported findings in toxic overdoses with ventricular arrhythmias being reported as the leading cause of death. You can see Left Main and Proximal LAD obstruction, but with some flow, which is saving this patient's life. Subsequent PCI of the LMCA and LAD was performed.

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Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Dr. Smith's ECG Blog

She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. A 60-something woman presented after a witnessed cardiac arrest. CPR was started immediately.

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ToxCard: Bupropion

EMDocs

Questions: What are the clinical manifestations of bupropion overdose? How is bupropion overdose treated? How long should a patient be observed after a bupropion overdose? In 2020, bupropion was the 18 th most-prescribed medication in the USA. In 2020, bupropion was the 18 th most-prescribed medication in the USA.