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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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Transcutaneous Pacing: Part 2

EMS 12-Lead

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.

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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. Disposition to ICU. Circulation.

Overdose 246
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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
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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.

Naloxone 236
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SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest

The Skeptics' Guide to EM

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Resuscitation 2023.

CPR 217
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SGEM#238: The Epi Don’t Work for OHCA

The Skeptics' Guide to EM

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.