Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Both norepinephrine and epinephrine can be used. Epinephrine is key if there is significant bradycardia. Never fear.

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E-9-1-1 Epinephrine ALS EMS 300

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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Epinephrine Emergency Department ALS Critical Care 98

The Skeptics' Guide to EM

DECEMBER 7, 2018

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.

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Epinephrine Life Support Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

DECEMBER 25, 2021

” Reference: Vallentin et al. Case: An EMS crew arrives at the home of a 68-year-old suffering from a witnessed out-of-hospital cardiac arrest (OHCA). Intraosseous access is quickly obtained, and a dose of epinephrine is provided. Reference: Vallentin et al. As a reminder, here are the five rules for SGEM JC.

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Epinephrine CPR ALS Emergency Department 130

EMDocs

OCTOBER 29, 2024

Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA), Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

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The Skeptics' Guide to EM

OCTOBER 31, 2020

She is the host of EM Bootcamp in Las Vegas, as well as a usual speaker and faculty member for The Center for Continuing Medical Education (CCME). She is the host of EM Bootcamp in Las Vegas, as well as a usual speaker and faculty member for The Center for Continuing Medical Education ( CCME ). Reference: Vent et al.

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Epinephrine Emergency Department EMS ALS 130

REBEL EM

APRIL 29, 2024

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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ALS Epinephrine Critical Care Emergency Department 105

EMS 12-Lead

MARCH 30, 2024

After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). Junctional Rhythm, occasional PAC's, and artifact.

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CPR Paramedic Ambulance Defibrillator 312

Pediatric EM Morsels

OCTOBER 27, 2023

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. 2020) The Times & Tapes Are a-Changin’: The Latest Broselow-Luten Tape for EMS , EMS World.

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E-9-1-1 Emergency Medical Services Life Support ALS 269

ACEP Now

NOVEMBER 6, 2024

mg/kg IV epinephrine, or 0.05–0.1 3 Dr. Turner , originally trained at the Medical University of South Carolina, is an EM intern at Hershey Medical Center in Hershey, Pa. Garvey AA, Dempsey EM. Aziz K, Lee HC, Escobedo MB, et al. ET tube size should be 2.5 mm for neonates under 1,000 grams, 3.0 Adv Med Educ Pract.

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Epinephrine Emergency Department EMS OR 98

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. N Engl J Med. 2015; 372(5):418-25. 2013;24:53-66.

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Frozen Plasma Allergic Reaction FFP Plasma 105

ACEP Now

JULY 7, 2023

2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. 5 More recent literature defines “refractory” as VT or VF that is persistent or recurrent despite three shocks from a defibrillator, three rounds of epinephrine, and use of an antiarrhythmic (i.e.,

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Defibrillator OR ALS Epinephrine 98

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. display_podcast] Date: September 21st, 2018 Reference: Kawano et al.

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BLS Defibrillator Critical Care CPR 130

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

[display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. You need to recognize an arrest and activate your EMS system. JAMA 2009 * Jacobs et al. Resuscitation 2011 * Hagihara et al. Academic Emergency Medicine. September 2017.

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Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Alongside his EM residency, he is doing a PhD in epidemiology. Alongside his EM residency, he is doing a PhD in epidemiology. Reference: Roberts et al. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest.

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Epinephrine Emergency Department EMS ALS 130

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. Carsten L, et al.

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Defibrillator CPR Epinephrine Life Support 84

The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient. Reference: Benger et al, Effect of a Strategy of a Supraglottic Airway Device
vs. The AIRWAYS-2 Randomized Clinical Trial.

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CPR Firefighter Paramedic Defibrillator 130

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] If epinephrine is used, small initial doses ( <1 ug/kg) are preferred.

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E-9-1-1 Plasma Epinephrine Life Support 93

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

[display_podcast] Date: September 12th, 2017 Reference: Sinert et al. He is also part of REBEL EM, The Teaching Course, […] The post SGEM#188: Icatibant Bites the Dust – For ACE-I Induced Angioedema first appeared on The Skeptics Guide to Emergency Medicine. display_podcast] Date: September 12th, 2017 Reference: Sinert et al.

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Epinephrine ALS Emergency Department EMS 130

REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. References: Ibarra-Estrada, M et al. PMID: 36915146 [ Access on Read by QxMD ] Kirov MY et al. PMID: 11588440 Memis D et al. PMID: 12500513 Lopez A et al. PMID: 14707556 Richards-Belle et al. appeared first on REBEL EM - Emergency Medicine Blog. Crit Care 2023.

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ICU ALS Epinephrine OR 145

The Skeptics' Guide to EM

APRIL 20, 2019

Date: April 17th, 2019 Reference: Little et al. Date: April 17th, 2019 Reference: Little et al. Talk Trauma is a two-day conference for nurses, allied health and EMS professionals involved in providing care for the adult and paediatric trauma patient. Major trauma: Does weekend attendance increase 30-day mortality?

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Epinephrine ALS Emergency Department EMS 100

Silk City Blog

DECEMBER 6, 2022

Written by Amanda Hall, DO This post first appeared on REBEL EM Background: Epistaxis is a common ailment experienced by millions worldwide. When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization.

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Epinephrine EMS ED ALS 40

REBEL EM

NOVEMBER 6, 2023

Paper: Hiruy A, et al. to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5) REFERENCES: Hiruy A, et al. PMID: 37586951 Mehaffey JH, et al.

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ICU Epinephrine ALS OR 72

REBEL EM

SEPTEMBER 1, 2022

Paper: Vallentin MF et al. References: Vallentin MF et al. Additionally, there were non-statistically significant trends toward lower survival and lower survival with good neurologic outcomes in patients receiving calcium at 30 to 90 days. It is unknown whether these harms are present at long-term follow up. Resus 2022. Placebo: 9.1%

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Epinephrine Overdose ALS OR 52

NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. al answered this question with a prospective observational study which showed a significantly shorter time interval to obtain tibial IO access (4.6 1] Table from Hamam et al.

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E-9-1-1 Advanced Life Support Epinephrine Life Support 52

REBEL EM

SEPTEMBER 19, 2022

Some look promising (ie eCPR and application of US) while others have been considerably less effective or inconsistent (ie epinephrine and targeted temperature management). Article: Moore JC et al. Population: Patients > 18 years of age w/ OHCA treated by 10 EMS systems in in the US. However, human data is sorely lacking.

CPR 52

CPR Defibrillator EMS Epinephrine 52

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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E-9-1-1 Epinephrine ED ALS 52

ACEP Now

NOVEMBER 14, 2023

Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column. 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. Wand O, Guber E, Guber A, et al.

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Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. Epinephrine infusion was begun. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck.

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Defibrillator Coronary ALS STEMI 113

NAEMSP

APRIL 19, 2023

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., Calcium acts as a vasopressor and inotropic agent (Lindqwister, et al., He is found to be in ventricular fibrillation (VF).

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E-9-1-1 Advanced Life Support Overdose CPR 52

FOAMfrat

OCTOBER 20, 2023

And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. Dr. Jarvis of The EMS Lighthouse Project podcast also covers this paper in detail here: [link] ^^^ I highly recommend listening!

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E-9-1-1 ALS ACS OR 52

REBEL EM

JANUARY 23, 2023

Article: Abella BS et al. Noninferiority trials, covered here on REBEL EM , are helpful when the experimental treatment offers a distinct advantage over the standard treatment. Zuberbier, Torsten, et al. Moreover, the FDA approved intravenous (IV) cetirizine to treat acute urticaria in 2019. Ann Emerg Med 2020. PMID: 14767453.

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Allergic Reaction ED E-9-1-1 Emergency Department 52

REBEL EM

SEPTEMBER 26, 2022

Article: Kumar M et al. It’s unclear whether interventions such as cauterization, clip placement, epinephrine injection, etc., References De Pietri L, Bianchini M, Montalti R, et al. PMID: 31229583 Kumar M, Ahmad J, Maiwall R, et al. PMID: 31148204 Rout G, Shalimar, Gunjan D, et al. Hepatology. 2020;71(1):235-246.

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FFP E-9-1-1 ICU ALS 52

EMDocs

JANUARY 20, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. link] Lee VH, Connolly HM, Fulgham JR, Manno EM, Brown RD Jr, Wijdicks EF. Updated 2023 Jan 9].

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ECG Medical Training

DECEMBER 4, 2016

Alongside tracheal intubation , response times , and fire-based EMS, this is one of the most controversial topics in prehospital medicine. This is important because too many EMS systems look at mechanical CPR as a way to avoid having to become experts in resuscitation or having to send additional resources to the scene.

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CPR E-9-1-1 Defibrillator Ambulance 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension. Taglieri N, Marzocchi A, Saia F, et al. REFERENCES : 1.

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Coronary ACS ALS STEMI 52

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. 34 If a MAP of 65 mmHg is still not achieved, epinephrine should be added as a third agent (Figure 1). Evidence continues to support norepinephrine, vasopressin, and epinephrine as the order of vasopressor initiation, respectively, titrated to MAP of 65 mmHg.

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