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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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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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% Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. compared to only 37.5% in the CVC group.

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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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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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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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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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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. Recommended by ATLS and PALS.

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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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The Skeptics' Guide to EM

MARCH 5, 2022

Date: February 24th, 2022 Reference: Parish et al. Date: February 24th, 2022 Reference: Parish et al. Tricoci et al. The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. They wonder how strong the evidence is for much of what we do in emergency medicine.

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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! Read the Full Case Study Here Ready to Try Handtevy Mobile?

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EMS Emergency Medical Services Epinephrine ALS 52

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. Pediatr Nephrol.

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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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Core EM

JANUARY 25, 2024

link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. Blocks with larger volumes of anesthetic carry higher risk of LAST.

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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. Myth #1: The use of non-selective NSAIDs will cause a nonunion in long bone fractures When bones break, they usually heal with either surgical or non-surgical management. J Bone Joint Surg Am.

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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. Patients were also excluded if incarcerated or pregnant.

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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.

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REBEL EM

JUNE 12, 2024

References Gummin DD, Mowry JB, Beuhler MC, et al. Insulin versus vasopressin and epinephrine to treat beta-blocker toxicity. REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia Therapy Click here for Direct Download of the Podcast. 1 Recall that cardiac output is a function of both stroke volume and heart rate. 1 g/kg) IV.

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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 book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Resources The SAVIOR algorithm.

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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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EMDocs

APRIL 10, 2024

1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] 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. mL/kg/min. [2]

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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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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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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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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 minutes versus 5.4 minutes). [5]

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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.

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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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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 ). What are additional treatment options?

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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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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.

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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.

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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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Dr. Smith's ECG Blog

JUNE 19, 2023

Armstrong et al. The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. Here is his triage ECG which was obtained at 20:34 during active pain. What do you think? This ECG was read as “No STEMI” with no prior available for comparison. mm STE in III, and possibly 0.5

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AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard H, Soreide E, de Haas, I et al. Kirkegaard et al. Question: What is the current available evidence on: temperature degree, duration and method of cooling in TTM patients post cardiac arrest? New Engl J Med. doi: 10.1001/jama.2017.8978.

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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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Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. 3–8 Shi et al. 3–8 Shi et al. The physicians found him to be in s hock, with very poor O2 saturations. He was intubated and then went pulseless.

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Dr. Smith's ECG Blog

FEBRUARY 8, 2015

The data in the paper by Rangel et al. They had already cardioverted at 120 J, then 200 J, which resulted in the following: Ventricular Tachycardia They then cardioverted at 200 J which r esulted in the same narrow complex rhythm shown above, at 185 beats per minute. I suggested esmolol if the heart rate did not improve. Monitor Lead I.

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