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

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.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

REBEL EM

DECEMBER 5, 2023

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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Epinephrine Allergic Reaction Emergency Department Emergency Management 80

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

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.

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CPR Defibrillator Epinephrine Firefighter 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

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.

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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).

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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.

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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.

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Epinephrine Critical Care Life Support Emergency Department 100

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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Naloxone Overdose Epinephrine ALS 169

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.

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Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. There is no evidence for a patient-oriented benefit with epinephrine ( SGEM#238 ), other ACLS drugs ( SGEM#64 ), pre-hospital therapeutic hypothermia ( SGEM#54 , SGEM#183 ), or mechanical CPR ( SGEM#136 ).

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CPR Firefighter Paramedic 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 ).

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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.

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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).

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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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Epinephrine ALS 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.

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CPR ICU Critical Care Defibrillator 130

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

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 101

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. Crit Care 2023. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

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ICU ALS Epinephrine OR 145

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Reference: Roberts et al. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. Alongside his EM residency, he is doing a PhD in epidemiology. Audrey’s academic interests include trauma and resuscitation. Outside of medicine, Audrey likes to play rugby and run.

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Epinephrine Emergency Department EMS ALS 130

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 Emergency Department OR 246

Critical Care Scenarios

MAY 31, 2020

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). .* The flip side of hypoxic vasoconstriction is hyperoxic vasodilation of the pulmonary vasculature—i.e. an overly high FiO2 will tend to worsen V/Q matching.*

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Critical Care Epinephrine ED ALS 100

The Skeptics' Guide to EM

APRIL 20, 2019

Date: April 17th, 2019 Reference: Little et al. Date: April 17th, 2019 Reference: Little et al. To get the crowd warmed up for our nerdy structured critical appraisal we reviewed a paper by Dr. Esther Choo et al. Major trauma: Does weekend attendance increase 30-day mortality?

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Epinephrine ALS Emergency Department EMS 100

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.

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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.

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Coronary Life Support ALS Emergency Department 98

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al.

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Defibrillator CPR Epinephrine Life Support 108

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

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

ACEP Now

NOVEMBER 6, 2024

mg/kg IV epinephrine, or 0.05–0.1 Aziz K, Lee HC, Escobedo MB, et al. ET tube size should be 2.5 mm for neonates under 1,000 grams, 3.0 mm for 1,000–2,000 grams, and 3.5 for neonates over 2,000 grams. 1 ET depth is generally “6 + the weight in kilograms,” so a three kg infant would have an ET tube be nine cm at the lip. 2016;8:11-19.

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Epinephrine Emergency Department EMS OR 98

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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Epinephrine ICU ALS OR 71

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. In such cases — radiofrequency ablation of ectopic beats triggering malignant ventricular arrhythmias was needed for control of arrhythmic storm because the antiarrhythmic medications tried were ineffective ( Marrouche et al — JACC 5;43(9): 1715-20, 2004 ).

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Defibrillator Coronary ALS STEMI 131

Handtevy

MAY 10, 2024

IM Epinephrine for Anaphylaxis : Correct dosing is common, with improved times to administration. Survey Insights Post-Handtevy: 96% of ALS clinicians use Handtevy Mobile. Study Results Highlight: Midazolam for Seizure : Error-free dosing in the last quarter of 2023!

EMS 52

EMS Emergency Medical Services Epinephrine ALS 52

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

ECG & Echo Learning

OCTOBER 2, 2022

Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 References Overgaard, Dzavik et al. Jentzer et al. Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Gattinoni L, Brazzi L, Pelosi P, et al. Circulation 2011.

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