Remove ALS Remove Critical Care Remove Epinephrine
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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). References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al. Intensive Care Med.

Overdose 246
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The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults

REBEL EM

1-4 The PDPs, phenylephrine and epinephrine, result in vasoconstriction and increased cardiac contractility. They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Paper: Singer S, et al. Am J Emerg Med. 2022 Sep 5.

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SGEM#350: How Did I Get Epi Alone? Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrests

The Skeptics' Guide to EM

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. Epinephrine is provided and you quickly place an advanced airway. JAMA Sept 2021. JAMA Sept 2021. The monitor shows a non-shockable rhythm.

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SGEM#392: Shock Me – Double Sequential or Vector Change for OHCAs with Refractory Ventricular Fibrillation?

The Skeptics' Guide to EM

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Research interests include simulation-based assessment, transport medicine, and critical care analgesia. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation.

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SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest

The Skeptics' Guide to EM

Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.

CPR 130
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Don’t Forget About the IO in the Critically Ill Patient

REBEL EM

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line.

ALS 105
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Neurogenic Shock in Children

Pediatric EM Morsels

Both norepinephrine and epinephrine can be used. Epinephrine is key if there is significant bradycardia. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Crystalloid may help, but neurogenic shock may not respond to fluid administration. References Coleman-Satterfield, TT.

E-9-1-1 300