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In this call, paramedics arrived on scene to find a patient apneic and pulseless with CPR in progress by first responders (AED had an unknown unshockable rhythm). Patient had an unwitnessed cardiac arrest without bystander CPR performed. Epinephrine administered intravenously. They administered 10 mcg of push-dose epinephrine.
The paramedics begin CPR. CPR is performed with manual compressions as no mechanical CPR device is available. After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). They are unable to feel a pulse and resume CPR. Intubation is attempted, but unsuccessful. Current 85mA.
Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Resuscitation 2023.
Date: September 18, 2024 Reference: Dillon et al. On arrival, you find a 35-year-old male, pulseless and apneic with cardio-pulmonary resuscitation (CPR) in progress by a bystander. You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine.
Date: October 18th, 2022 Reference: Moore et al. Case: You are the Chief of your local Fire and EMS Department, and an individual contacts you saying […] The post SGEM#380: OHCAs Happen and You’re Head Over Heels – Head Elevated During CPR? Date: October 18th, 2022 Reference: Moore et al.
Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. JAMA 2009, Hagihara et al. JAMA 2012 and Cournoyer et al.
” Reference: Vallentin et al. Bystander CPR is being performed. The paramedics performed high-quality CPR and follow their ACLS protocol. Intraosseous access is quickly obtained, and a dose of epinephrine is provided. CPR is continued while a supraglottic airway is placed successfully.
[display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. Bystander high-quality CPR can buy you some time until defibrillation. JAMA 2009 * Jacobs et al. Resuscitation 2011 * Hagihara et al. Academic Emergency Medicine.
Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. He confirms pulselessness, initiates CPR, gets a colleague to call 911, and intubates the patient on the floor. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation.
Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. It required multiple attempts which caused several prolonged interruptions in CPR. Key to survival is high-quality CPR and early defibrillation. Key to survival is high-quality CPR and early defibrillation.
Date: January 5th, 2021 Reference: Grunau et al. Date: January 5th, 2021 Reference: Grunau et al. CPR is currently in progress with a single shock having been delivered. Reference: Grunau et al. first appeared on The Skeptics Guide to Emergency Medicine. Different countries have different approaches to this problem.
Reference: Cashen K, Reeder RW, Ahmed T, et al. Reference: Cashen K, Reeder RW, Ahmed T, et al. Your team begins high quality cardiopulmonary resuscitation (CPR). Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. Pediatric Crit Care Med.
[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Bystander CPR is initiated prior to EMS arrival. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic.
Date: November 10th, 2021 Reference: Andersen, et al: Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest. Cardiopulmonary resuscitation (CPR) is in progress. Epinephrine is provided and you quickly place an advanced airway. JAMA Sept 2021.
Cardiac Care Show – Episode #1: Mechanical CPR Hello, and welcome to the Cardiac Care Show. In today’s episode I’d like to talk about mechanical CPR, which is a frequent topic of conversation in the Resuscitation group on Facebook and the #FOAMed community on Twitter. So, mechanical CPR is a no-brainer, right?
Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Head Up (HUP) CPR may be the next critical improvement. Head Up (HUP) CPR may be the next critical improvement. Article: Moore JC et al.
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.
After resuming CPR and administering an additional 400 mcg IV NTG, the patient achieved return of spontaneous circulation with sinus tachycardia. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Myerburg RJ, Kessler KM, Mallon SM et al.
Meyer MD Clinical Scenario You are dispatched to a 57-year-old male with a witnessed cardiac arrest and bystander CPR being performed. Your partner deploys the cardiac monitor and while CPR is continued you turn your attention to establishing vascular access. 1] Table from Hamam et al. minutes versus 5.4 minutes). [5]
CPR is taken over by responding crews, and he is placed on a cardiac monitor/defibrillator. After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al.,
1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard et al.
It was witnessed, and CPR was performed by trained individuals. Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device.
Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. With ventilations and epinephrine, she regained a pulse. Kurkciyan et al. Kurkciyan et al., A middle-age woman with h/o hypertension was found down by her husband. In 25 (93%), the initial rhythm was asystole or PEA.
He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. 3–8 Shi et al. Sandoval Y, Smith SW, Sexter A, et al. Shi S, Qin M, Shen B, et al. Guo T, Fan Y, Chen M, et al. Lala A, Johnson KW, Russak AJ, et al.
the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. We could not resuscitate her, but we did have excellent perfusion with LUCAS CPR, such that pulse oximetry had excellent waveform and 100% saturations, end tidal CO2 was 35, and cerebral perfusion monitoring was near normal throughout the attempted resuscitation.
[display_podcast] Date: June 20th, 2017 Reference: Bernard et al. display_podcast] Date: June 20th, 2017 Reference: Bernard et al. By-standard CPR is started and EMS is called. The Cochrane Collaboration updated their review on hypothermia for neuroprotection in adults after CPR in 2012. Reference: Bernard et al.
Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. 1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). Larribau R, Deham H, Niquille M, et al.
Nizami T, Beaudoin F, Suner S, et al. Reviewed by: Vicki Currie Article 5: Does occluding the femoral artery during neonatal CPR increase the likelihood of ROSC? (In Disease relapse should not automatically be assumed to mean failure of therapy. Crocker, B.C.S., Emergency Medicine Journal 2023;40:564-568.
REBEL Cast Ep113 – Defibrillation Strategies for Refractory Ventricular Fibrillation Click here for Direct Download of the Podcast Paper: Cheskes S, et al. In fact, 4000 paramedics in total were not only trained in the study protocol but also given a rigorous evaluation of their ability to perform CPR. N Engl J Med.
Date: November 10, 2024 Reference: Couper et al. After starting cardiopulmonary resuscitation (CPR), you note pulseless electrical activity (PEA) on the monitor. The paramedic is trying to get intravenous (IV) access to give epinephrine per the protocol. Epinephrine has long been a cornerstone in the management of OHCA.
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