Remove ALS Remove Definition Remove 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. 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. One critical consideration in prehospital epinephrine administration is the method of vascular access.

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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. You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine. Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open.

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Neurogenic Shock in Children

Pediatric EM Morsels

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. 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.

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Clinical Conundrums: How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis?

REBEL EM

How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? Bottom Line Up Top: After prompt recognition and appropriate treatment with IM epinephrine, the risk of biphasic reactions are exceedingly low. At the time of discharge, appropriate patient education and prescriptions for IM epinephrine are essential.

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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#247: Supraglottic Airways Gonna Save You for an OHCA?

The Skeptics' Guide to EM

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. They had a difficult time getting a definitive airway pre-hospital. Reference: Benger et al, Effect of a Strategy of a Supraglottic Airway Device
vs. Effect of a Strategy of a Supraglottic Airway Device
vs.

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

REBEL EM

A study by Lee et al ( 7) compared femoral CVC placement to IO and demonstrated a first-pass success pass rate with IO of 90.3% In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. References: 1 Astasio-Picado Á et al. Ong MEH, Chan YH, Oh JJ, et al. Iserson KV et al.

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