The Skeptics' Guide to EM

DECEMBER 25, 2021

” Reference: Vallentin et al. Intraosseous access is quickly obtained, and a dose of epinephrine is provided. Reference: Vallentin et al. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest – A Randomized Clinical Trial.

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Epinephrine CPR ALS Emergency Department 130

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

OCTOBER 22, 2022

Date: October 18th, 2022 Reference: Moore et al. Date: October 18th, 2022 Reference: Moore et al. This includes epinephrine for OHCA, target temperature management, mechanical CPR, supraglottic airways, steroids, hands on defibrillation and many more topics. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

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. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. and Seaver, M. Rosenberg, M.S.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

The Skeptics' Guide to EM

OCTOBER 31, 2020

Reference: Vent et al. Buffered lidocaine 1%, epinephrine 1:100,000 with sodium bicarbonate (hydrogencarbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. . Epinephrine in Local Anesthetics: This will not make the tip of things fall off (nose, fingers, toes, etc).

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. first appeared on The Skeptics Guide to Emergency Medicine. Defibrillation Strategies for Refractory Ventricular Fibrillation.

Defibrillator 142

Defibrillator Medical Transportation OR CPR 142

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

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

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. There have been a number of papers published since OPALS that support the findings of not using ACLS drugs like epinephrine for OHCA: * Olavseengen et al. September 2017.

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. Date: January 5th, 2021 Reference: Grunau et al. This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ).

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

[display_podcast] Date: September 12th, 2017 Reference: Sinert et al. display_podcast] Date: September 12th, 2017 Reference: Sinert et al. epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will not work. Reference: Sinert et al.

Epinephrine 130

Epinephrine ALS Emergency Department EMS 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. display_podcast] Date: September 21st, 2018 Reference: Kawano et al. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. EMS arrives on scene and initiates high quality basic life support (BLS).

BLS 130

BLS Defibrillator Critical Care CPR 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.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

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. 1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353. Pediatric Crit Care Med. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Defibrillator 130

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.

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

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.,

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

The Skeptics' Guide to EM

JUNE 24, 2017

[display_podcast] Date: June 20th, 2017 Reference: Bernard et al. display_podcast] Date: June 20th, 2017 Reference: Bernard et al. They continue CPR, get intravenous access, give a round of epinephrine and then wonder if they should start rapid cooling en-route to the hospital with some cold saline. Reference: Bernard et al.

CPR 100

CPR Epinephrine ALS Paramedic 100

The Skeptics' Guide to EM

FEBRUARY 20, 2021

SGEM#317: Dese bones gonna heal again, with or without a non-selective NSAID Reference: George et al. SGEM Bottom Line: There is no high-quality evidence to support the claim that non-selective NSAIDS cause an increased risk of nonunion. Risk of Nonunion with Nonselective NSAIDs, COX-2 Inhibitors, and Opioids. J Bone Joint Surg Am.

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Epinephrine ALS OR 130

Core EM

JANUARY 25, 2024

link] [3] Morrison RS, Magaziner J, Gilbert M, et al. 15-30 5-24 Adverse effects : Infection Vascular injury including hematoma or pseudoaneurysm formation Nerve damage Local anesthesia systemic toxicity (LAST) – confusion, anxiety, headache, drowsiness, hypotension, arrhythmias including ventricular tachycardia or fibrillation.

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Epinephrine ED OR Emergency Department 246

Don't Forget the Bubbles

DECEMBER 25, 2023

Disease-Oriented Outcomes (DOOs) The PARAMEDIC-2 trial looked at the effectiveness of epinephrine in adult patients who suffered an out-of-hospital cardiac arrest. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% doi:10.1136/bmjebm-2018-110891 Perkins GD, Ji C, Deakin CD, et al.

Epinephrine 83

Epinephrine ALS OR Paramedic 83

ACEP Now

DECEMBER 6, 2024

Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. References Prinzmetal M, Kennamer R, Merliss R, et al. Myerburg RJ, Kessler KM, Mallon SM et al. Magid DJ, Aziz K, Cheng A, et al. Kousik SM, Graves SM, Napier TC, et al.

Coronary 98

Coronary Life Support ALS Emergency Department 98

EMDocs

APRIL 10, 2024

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. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al. 5,8] In one review the incidence of LAST was estimated to be 2.7

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

Don't Forget the Bubbles

MAY 8, 2024

Dell KM, et al. Eisen S et al. Fielder AR, et al. 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. Chiang HL, et al. Wong J, et al. Fuller S et al. Koenis MM et al.

E-9-1-1 69

E-9-1-1 ALS Emergency Department Epinephrine 69

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.

ICU 71

ICU Epinephrine ALS OR 71

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%

Epinephrine 52

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.

E-9-1-1 52

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

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. References Go AS, Mozaffarian D, Roger VL, et al. Larribau R, Deham H, Niquille M, et al. Margey R, Browne L, Murphy E, et al. Kudenchuk PJ, Brown SP, Daya M, et al. Spies DM, Kiekenap J, Rupp D, et al. Circulation.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

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. style='mso-element:field-begin'> ADDIN EN.CITE Rangel 1853 1853 17 Rangel, C.

E-9-1-1 52

E-9-1-1 Coronary Epinephrine Overdose 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. Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds.

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

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. Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds.

Epinephrine 40

Epinephrine EMS ED ALS 40

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. References: Moore JC et al. Additionally, there is ongoing research into targeting improvements in the interventions we know work.

CPR 52

CPR Defibrillator EMS Epinephrine 52

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).

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 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 was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. see below). I have never seen this, but it is possible.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

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.

Epinephrine 52

Epinephrine ED Emergency Department ALS 52

REBEL EM

JANUARY 23, 2023

Article: Abella BS et al. Zuberbier, Torsten, et al. Moreover, the FDA approved intravenous (IV) cetirizine to treat acute urticaria in 2019. Clinical Question: Is IV cetirizine noninferior to IV diphenhydramine for the treatment of acute urticaria? Ann Emerg Med 2020. J Allergy Clin Immunol. 2004 Feb;113(2):347-52. PMID: 14767453.

Allergic Reaction 52

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

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. Safian RD, Berman AD, Diver DJ, et al. Hutter AM Jr, De Sanctis RW, Nathan MJ, et al.

Coronary 40

Coronary ACS ALS STEMI 40

REBEL EM

DECEMBER 19, 2022

REBEL Cast Ep113 – Defibrillation Strategies for Refractory Ventricular Fibrillation Click here for Direct Download of the Podcast Paper: Cheskes S, et al. REFERENCES: Cheskes S, et al. 2022 Nov 6 PMID: 36342151 Cheskes S, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. N Engl J Med.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

EMS 12-Lead

MAY 15, 2024

Epinephrine administered intravenously. After 13 minutes of ALS resuscitation, pulses were palpated indicating a return of spontaneous circulation. They administered 10 mcg of push-dose epinephrine. Atropine and further doses of epinephrine were not administered. Approach TCP with skepticism.

Epinephrine 331

Epinephrine Paramedic CPR EMT 331