Remove ALS Remove Epinephrine Remove ICU
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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). Disposition to ICU. References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al.

Overdose 246
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The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults

REBEL EM

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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emDOCs Revamp: Left Ventricular Outflow Tract Obstruction

EMDocs

He was started appropriately on vancomycin and cefepime and accepted for ICU admission but remains in the ED due to boarding and bed lock. Left ventricular outflow tract obstruction in ICU patients. doi:10.1016/S0033-0620(05)80036-2 Balik M, Novotny A, Suk D, et al. doi:10.3390/JCM13185344 Yamagishi T, Tanabe T, Fujita H, et al.

E-9-1-1 87
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SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest

The Skeptics' Guide to EM

Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).

CPR 130
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Adjunctive Methylene Blue in Septic Shock?

REBEL EM

Paper: Ibarra-Estrada, M et al. What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 Limited, small studies on its use in septic shock do not make a clear argument for use. Crit Care 2023.

ICU 145
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Hydroxycobalamin vs Methylene Blue for Vasoplegic Shock from Cardiopulmonary Bypass

REBEL EM

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 72
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ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

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. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. BMJ Case Rep.

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