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Transcutaneous Pacing: Part 2

EMS 12-Lead

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.

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SGEM#462: Spooky Scary Access – IV or IO for OHCA

The Skeptics' Guide to EM

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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Transcutaneous Pacing: Part I

EMS 12-Lead

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.

CPR 312
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SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest

The Skeptics' Guide to EM

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.

CPR 219
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SGEM#380: OHCAs Happen and You’re Head Over Heels – Head Elevated During CPR?

The Skeptics' Guide to EM

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.

CPR 130
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SGEM#453: I Can’t Go For That – No, No Narcan for Out-of-Hospital Cardiac Arrests

The Skeptics' Guide to EM

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.

Naloxone 239
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SGEM#238: The Epi Don’t Work for OHCA

The Skeptics' Guide to EM

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.