REBEL EM

JUNE 8, 2023

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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Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Most emergency drugs except for amiodarone and succinylcholine are based on ideal body weight [Emergency Medical Services for Children, Luten 2007] Epinephrine, dopamine, fentanyl, ketamine based on what child should weigh.

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The Skeptics' Guide to EM

NOVEMBER 13, 2021

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. Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED). JAMA Sept 2021. JAMA Sept 2021.

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Core EM

JANUARY 25, 2024

1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Door-to-block time: prioritizing acute pain management for femoral fractures in the ED. J Gerontol A Biol Sci Med Sci. 2003;58(1):76-81.

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ALiEM

NOVEMBER 29, 2023

Xylazine is an alpha-2 agonist similar to clonidine that inhibits the release of norepinephrine and epinephrine resulting in decreased vascular tone and heart rate [4]. PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. PMID: 36148197 Love JS, Levine M, Aldy K, et al.

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The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. Date: January 5th, 2021 Reference: Grunau et al. Case: During a busy emergency department (ED) shift the paramedic phone rings. Reference: Grunau et al. first appeared on The Skeptics Guide to Emergency Medicine.

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The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. Reference: Cashen K, Reeder RW, Ahmed T, et al. Case: A 6-month-old boy presents to the emergency department (ED) with three days of worsening cough, cold symptoms, and fever. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).

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ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al.

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Critical Care Scenarios

MAY 31, 2020

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. To hemodynamically manage RV failure without worsening RV afterload, consider the Rule of 8s cocktail:* Epinephrine.08 Figure 1 from Srour et al (vide infra).

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Critical Care Epinephrine ED ALS 100

REBEL EM

SEPTEMBER 13, 2023

Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. Zuraw et al. In: UptoDate, Feldweg AM (ed.) N Engl J Med.

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Frozen Plasma Allergic Reaction FFP Plasma 101

EMDocs

APRIL 10, 2024

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] doi:10.1007/BF03161199 Olson K, Smollin C, eds.

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EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. Carsten L, et al. Forti A, Brugnaro P, Rauch S, et al.

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Defibrillator CPR Epinephrine Life Support 109

ACEP Now

DECEMBER 6, 2024

Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga., References Prinzmetal M, Kennamer R, Merliss R, et al. Myerburg RJ, Kessler KM, Mallon SM et al.

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Coronary Life Support ALS Emergency Department 98

ACEP Now

NOVEMBER 6, 2024

A gravid woman presents to your emergency department (ED). mg/kg IV epinephrine, or 0.05–0.1 Aziz K, Lee HC, Escobedo MB, et al. Before you can obtain any history, she gives birth in your waiting room. The neonate is apneic and has a heart rate of 48. How do you stabilize this patient? ET tube size should be 2.5 2016;8:11-19.

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REBEL EM

JANUARY 23, 2023

Article: Abella BS et al. Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 Anecdotally, the persistence of urticaria often has little influence on the decision to discharge a patient from the ED.

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REBEL EM

JULY 18, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit ( REBEL EM review ).

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Silk City Blog

DECEMBER 6, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit (REBEL EM review). Am J Emerg Med.

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ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. Atchinson PRA, Hatton CJ, Roginski MA, et al. Ittrich H, Bockhorn M, Klose H, et al. Li H, Ding X, Zhai S, et al. Kathuria H, Hollingsworth HM, Vilvendhan R, et al. 2021;42(1):145-159.

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Dr. Smith's ECG Blog

FEBRUARY 8, 2015

The data in the paper by Rangel et al. Lange RA, Cigarroa RG, Flores ED, et al. McCord J, Jneid H, Hollander JE, et al. Esmolol in the management of epinephrine- and cocaine-induced cardiovascular toxicity. is intuitive, and not surprising. Vittinghoff, E. ADDIN EN.CITE Lange 1990 734 734 17 Lange, R.A. McBride, W.

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Broome Docs

APRIL 6, 2023

Casey The CLOVERS trial: National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al. Epinephrine metered-dose inhaler for pediatric croup. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med.

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Epinephrine ED Emergency Department ALS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. She was hypotensive in the ED and her bedside echo showed a normal RV and LV. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. Kurkciyan et al.

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STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. see below). I have never seen this, but it is possible.

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Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. 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.

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Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. Dobutamine may be preferred in patients without severe hypotension who have high vascular resistance. -- De Backer D et al. Taglieri N, Marzocchi A, Saia F, et al. Kosuge M, Ebina T, Hibi K, et al. Richard, C; et al.

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Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Hypokalemia after cardiac arrest was independent of arterial pH, epinephrine or bicarbonate therapy during resuscitation, or prior therapy with diuretic drugs, digoxin or propranolol.

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EMDocs

DECEMBER 18, 2023

On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. 8,9 Recently, monocyte distribution width (MDW) has shown promise in a large meta-analysis as a useful screening tool in the ED.

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EMDocs

JANUARY 4, 2024

Other Norepinephrine or epinephrine are preferred vasopressors when needed. In: Brent J, et al. Eds (2017). Starr P, Klein-Schwartz W, et al. e4 Livshits Z, Feng Q, Chowdhury F, et al. Gosselin S, Hoegberg L, Hoffmann R, et al. PMID: 26856351 Stranges D, Lucerna A, Espinosa J, et al. Wu P, Juurlink D.

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Overdose E-9-1-1 ALS Emergency Department 92

Don't Forget the Bubbles

MAY 8, 2024

Dell KM, et al. Eisen S et al. Fielder AR, et al. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Bm MV, et al. Toepfner N, et al. Toniutti M, et al. Meoli M, et al. Ashton JJ, et al. Ding G et al. Tanti DC, et al. Ahlqvist VH, et al.

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ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. References Go AS, Mozaffarian D, Roger VL, et al. Circulation.

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Defibrillator E-9-1-1 ALS Epinephrine 52

Don't Forget the Bubbles

DECEMBER 5, 2023

Sex ed” sucks. They believe that Sex Ed programs are irrelevant to real-life experience and contain inadequate discussion of important issues, including consent or positive sexual relationships. Nizami T, Beaudoin F, Suner S, et al. Disease relapse should not automatically be assumed to mean failure of therapy. Crocker, B.C.S.,

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Coronary Epinephrine CPR Emergency Department 111

EMDocs

JANUARY 20, 2024

Prior to this intervention, management in the ED is mainly supportive of the patient’s hemodynamic and cardiac status. Rosh Review Website Link Further Reading Further FOAMed: [link] [link] References: Ahmad SA, Brito D, Khalid N, et al. doi:[link] Kosuge M, Ebina T, Hibi K, et al. Takotsubo Cardiomyopathy. 2014;8:CMC.S14086.

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EMDocs

OCTOBER 29, 2024

A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. doi:10.1016/S0033-0620(05)80036-2 Balik M, Novotny A, Suk D, et al. doi:10.1136/BCR-2018-225879 Dawood S, Hill A, Al Rawi O.

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Dr. Smith's ECG Blog

FEBRUARY 20, 2025

This is what the providers in the ED understood on patient arrival: Patient called 911 for syncope, then had witnessed PEA arrest after medics arrived. Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. Not a shockable rhythm. Resuscitation was begun with chest compressions, etc.,

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STEMI Paramedic E-9-1-1 Epinephrine 89

EMDocs

JANUARY 22, 2025

In the ED, he develops recurrent respiratory depression and hypoxia to 80%. How long should they stay in the ED? DOI: [link] O’Donnell J, Tanz LJ, Miller KD, et al. Al-Azzawi M, Alshami A, Douedi S, Al-Taei M, Alsaoudi G, Costanzo E. Available at: [link] October 19, 2023 Kelly A, Kerr D, Dietze P, et al.

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Naloxone E-9-1-1 Overdose NARCAN 96

EMDocs

MARCH 18, 2025

Airway: Key decision: base decision for intubation on clinical course, efficacy of airway clearance (coughing, mental status), ED/institutional resources, respiratory status (respiratory failure). Bronchoscopy can be used for bleeding control with cold saline, epinephrine, activated factor VIIa, or TXA. Am J Emerg Med. Am J Emerg Med.

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