The Skeptics' Guide to EM

JANUARY 13, 2024

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 223

CPR Defibrillator First Responder Epinephrine 223

Pediatric EM Morsels

SEPTEMBER 22, 2023

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. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Basics are the Best! 5 th Edition.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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.

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

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.

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 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% 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.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

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

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 Emergency Department Life Support 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.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

EMDocs

OCTOBER 29, 2024

m/s)—problematic and elevated > 50 mm Hg (2.5 m/s)—problematic and elevated > 50 mm Hg (2.5 m/s)—problematic and elevated > 50 mm Hg (2.5 m/s)—problematic and elevated > 50 mm Hg (2.5

E-9-1-1 86

E-9-1-1 ICU Epinephrine EMS 86

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

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

NOVEMBER 6, 2024

mg/kg IV epinephrine, or 0.05–0.1 Aziz K, Lee HC, Escobedo MB, et al. Neonatal resuscitation is common; 10 percent of the four million newborns in the U.S. each year will require at least some intervention. 1 However, one percent of births will require advanced interventions, including chest compressions, intubation, and medications.

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Epinephrine Emergency Department EMS OR 98

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

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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E-9-1-1 Emergency Medical Services Life Support ALS 269

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

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?

EMS 52

EMS Emergency Medical Services Epinephrine ALS 52

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 ).

CPR 130

CPR Firefighter Paramedic Defibrillator 130

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. Most of the research on the use of MB has been in patients with vasoplegia following cardiopulmonary bypass. Crit Care 2023. 95% CI 15.4 95% CI 15.4 95% CI 15.4

ICU 145

ICU ALS Epinephrine OR 145

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) This dysregulation of vasodilation is associated with a mortality of close to 25%.

Epinephrine 72

Epinephrine ICU ALS OR 72

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.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

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.

E-9-1-1 69

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

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.

Epinephrine 130

Epinephrine ALS OR 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. Patients were also excluded if incarcerated or pregnant.

BLS 130

BLS Defibrillator Critical Care CPR 130

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.

Critical Care 100

Critical Care Epinephrine ED ALS 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

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.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

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

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.

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

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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E-9-1-1 Plasma Epinephrine Life Support 92

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

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]

E-9-1-1 52

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

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?

Epinephrine 100

Epinephrine ALS Emergency Department EMS 100

ACEP Now

NOVEMBER 14, 2023

The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient. 2 Death from hemoptysis is akin to drowning, so airway considerations usually take precedence over hemodynamic considerations.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 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.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 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

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?

Defibrillator 113

Defibrillator Coronary ALS STEMI 113