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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. 2007;33(11):2019-2024.

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EM@3AM: Bacterial Tracheitis

EMDocs

2][3] Bacterial tracheitis should be suspected over croup if nebulized racemic epinephrine or steroids do not improve the clinical course. [2][3][8] Accessed August 11, 2024. Published 2024. Accessed August 11, 2024. 2] Suggested antibiotics include: ceftriaxone or cefotaxime + vancomycin or clindamycin. Published 2023.

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First10EM Journal Club: November 2024

Broome Docs

2024 Aug;201:110266. Epub 2024 Jun 9. PMID: 38857847 Bottom line: This before and after study demonstrates an association between early IM epinephrine and survival from cardiac arrest. 2024 Jul;8(7):482-490. Epub 2024 Jun 4. 2024 May-Jun;22(3):230-232. 2024 Jun 22:S0196-0644(24)00232-4. 2024.110266.

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emDOCs Podcast – Episode 112: Guillain-Barré Syndrome Part 2

EMDocs

Have push dose epinephrine at the bedside as induction can remove sympathetic tone and result in a vagal episode. Anyone with progressive symptoms or more findings on exam than paresthesias alone should be admitted to the hospital, likely to an ICU setting, due to the risk of decompensation. 2024 Jan;75:90-97. Am J Emerg Med.

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