The Skeptics' Guide to EM

DECEMBER 7, 2018

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). Date: December 6th , 2018 Reference: Perkins et al.

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The Skeptics' Guide to EM

DECEMBER 25, 2021

Bystander CPR is being performed. The paramedics performed high-quality CPR and follow their ACLS protocol. Intraosseous access is quickly obtained, and a dose of epinephrine is provided. CPR is continued while a supraglottic airway is placed successfully. The monitor is hooked up.

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The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Case: You are the medical director of an EMS system in a large city deciding on whether to respond to all out of hospital cardiac arrests (OHCA) with ACLS capabilities, or if resources should be directed to those candidates for extracorporeal CPR. Bystander high-quality CPR can buy you some time until defibrillation.

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Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

FEBRUARY 11, 2023

He confirms pulselessness, initiates CPR, gets a colleague to call 911, and intubates the patient on the floor. Case: A 60-year-old health professional suffers a cardiac arrest while working at a clinic outside the hospital. An anesthetist is working with him for the procedures.

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Defibrillator Medical Transportation OR CPR 139

The Skeptics' Guide to EM

MARCH 2, 2019

It required multiple attempts which caused several prolonged interruptions in CPR. Key to survival is high-quality CPR and early defibrillation. Key to survival is high-quality CPR and early defibrillation. What should you tell him? Background: We have covered OHCA many times on the SGEM.

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CPR Firefighter Paramedic Defibrillator 130

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Your team begins high quality cardiopulmonary resuscitation (CPR). Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base. 1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353.

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The Skeptics' Guide to EM

SEPTEMBER 29, 2018

Bystander CPR is initiated prior to EMS arrival. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. Case: A 46-year-old man has a cardiac arrest at home, witnessed by family. EMS arrives on scene and initiates high quality basic life support (BLS).

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The Skeptics' Guide to EM

JANUARY 9, 2021

CPR is currently in progress with a single shock having been delivered. 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

NOVEMBER 13, 2021

Cardiopulmonary resuscitation (CPR) is in progress. Epinephrine is provided and you quickly place an advanced airway. A second dose of epinephrine is given, and you start to think about reversible causes and your next steps for in-hospital cardiac arrests (IHCA). The monitor shows a non-shockable rhythm.

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Epinephrine Critical Care Life Support Emergency Department 100

ECG Medical Training

DECEMBER 4, 2016

Cardiac Care Show – Episode #1: Mechanical CPR Hello, and welcome to the Cardiac Care Show. In today’s episode I’d like to talk about mechanical CPR, which is a frequent topic of conversation in the Resuscitation group on Facebook and the #FOAMed community on Twitter. So, mechanical CPR is a no-brainer, right?

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CPR E-9-1-1 Defibrillator Ambulance 52

Handtevy

MARCH 14, 2018

All patients were treated on scene and epinephrine was administered within 5 minutes of arrival on scene. The post Pediatric High Performance CPR appeared first on Handtevy. Polk County Fire Rescue has deployed these techniques via our educational platform and recently reported their arrest statistics. What changed?

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CPR Epinephrine Critical Care EMS 52

EMDocs

JANUARY 8, 2024

Vasopressor medications during cardiac arrest We recommend that epinephrine be administered for patients in cardiac arrest. It is reasonable to administer epinephrine 1 mg every 3 to 5 minutes for cardiac arrest. High-dose epinephrine is not recommended for routine use in cardiac arrest. COR 1, LOE B-R. COR 2a, LOE B-R.

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Epinephrine Defibrillator Coronary CPR 83

Dr. Smith's ECG Blog

JULY 25, 2024

They started CPR. After 1 mg of epinephrine they achieved ROSC. Total prehospital meds were epinephrine 1 mg x 3, amiodarone 300 mg and 100 mL of 8.4% This patient was witnessed by bystanders to collapse. EMS arrived and found him in Ventricular Fibrillation (VF). He was defibrillated into VT. sodium bicarbonate.

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Defibrillator Coronary Epinephrine ACS 116

The Skeptics' Guide to EM

APRIL 4, 2020

Four Critical Care Controversies: * Round#1: Mechanical CPR – SGEM#136 * Round#2: Epinephrine in Out-of-Hospital Cardiac Arrest (OHCA) – SGEM#238 * Round#3: Stroke Ambulances with CT Scanners * Round#4: Bougie for First Pass Intubation – SGEM#271 Conclusion/Winner – Use EBM and the winner is the patient We appreciate Dr.

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Critical Care Epinephrine CPR Ambulance 130

REBEL EM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Head Up (HUP) CPR may be the next critical improvement. Head Up (HUP) CPR may be the next critical improvement. Resuscitation 2022; 179: 9-17.

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CPR Defibrillator EMS Epinephrine 52

EMDocs

APRIL 2, 2024

Today on the emDOCs cast Brit Long interviews Zachary Aust on the use of a mental model in post ROSC patients. Episode 98: Post ROSC Mental Model What’s the problem?

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CPR STEMI Epinephrine ICU 93

Dr. Smith's ECG Blog

APRIL 2, 2024

There was no bystander CPR. link] __ Case continued There was hypotension, initially controlled with an epinephrine infusion. An elderly man collapsed. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD.

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Defibrillator Coronary Epinephrine CPR 133

Peter Canning

JANUARY 14, 2024

I recerted CPR, ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advanced Life Support) late in December. When you are doing CPR and running cardiac arrests on a regular basis, it seems unnecessary to sit through a 2 hour class on CPR and 4 hour classes on ACLS and PALS. The certs are good for two years. mg via syringe.*

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CPR Naloxone Advanced Life Support EMT 52

The Overrun Podcast

MAY 23, 2019

Callelo: @DrDianeC, @njpoisoncenter, also at @ToxAndHound The COMBAT trial for prehospital plasma: [link] The PAMPHER trial: [link] BOKUTOH criteria study: [link] PARAMEDIC2 study of Epinephrine in OHCA: [link] Pediatric airway management in cardiac arrest: [link] Heads up CPR in OHCA: [link] And, why it may NOT be ready for EMS use, yet….

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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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Defibrillator CPR Epinephrine Life Support 85

Handtevy

APRIL 10, 2019

Bystander CPR, 2. Telephone CPR (T-CPR), and 3. Bystander CPR In the United States today, children in cardiac arrest have less than a 50% likelihood of receiving bystander CPR. Like adults, children who do not receive CPR prior to arrival of EMS have significantly decreased odds of survival.

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CPR Advanced Life Support EMS Epinephrine 52

NAEMSP

JANUARY 5, 2023

Meyer MD Clinical Scenario You are dispatched to a 57-year-old male with a witnessed cardiac arrest and bystander CPR being performed. Your partner deploys the cardiac monitor and while CPR is continued you turn your attention to establishing vascular access. On arrival to the scene, you find the patient pulseless and apneic.

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

NCOAE

NOVEMBER 13, 2021

How to stop bleeding, perform CPR, and assist breathing. Depending on the state, EMTs are authorized to administer 10 to 20 different medications, including epinephrine for an anaphylactic reaction, narcan for an overdose, or albuterol for an asthma attack. First Aid and to how to respond to a cardiac arrest.

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EMT EMT Emergency Medical Technician Ambulance Driver 52

TIMER

SEPTEMBER 28, 2022

This includes providing life-saving epinephrine to a patient having an allergic reaction, splinting a patient’s wounds following a car accident, or even performing CPR on a person experiencing cardiac arrest. They have received training in performing CPR and basic medical care.

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EMT EMT Paramedic Emergency Medical Technician 40

ACEP Now

DECEMBER 6, 2024

After resuming CPR and administering an additional 400 mcg IV NTG, the patient achieved return of spontaneous circulation with sinus tachycardia. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm.

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Coronary Life Support ALS Emergency Department 52

NAEMSP

APRIL 19, 2023

CPR is taken over by responding crews, and he is placed on a cardiac monitor/defibrillator. After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. His family has been performing bystander, and report that he suddenly collapsed just a few minutes ago.

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E-9-1-1 Advanced Life Support Overdose CPR 52

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical.

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E-9-1-1 CPR ICU ALS 52

My Paramedic Blog

FEBRUARY 21, 2015

Doctor: “Start CPR. More epinephrine went in via IV. I could feel the atmosphere in the room get heavier and heavier as we waited… And waited… And waited… Is this really supposed to take THIS long for the heart to restart?? We all knew things weren’t quite right. Don’t die on me! To wake up.

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Epinephrine CPR Paramedicine Paramedicine 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. Decision was made to push tPA after approximately 25 minutes of CPR, and after approximately 25 minutes after tPA was given, O2 saturation increased to 97%, and the patient was no longer cyanotic, converted to normal sinus rhythm with anterior lateral T wave inversions with ST depressions."

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ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

APRIL 29, 2020

CPR was started immediately. She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. EMS arrived and found her in a wide complex PEA rhythm.

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Defibrillator Epinephrine Coronary Overdose 52

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. A Rising Troponin That afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called.

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E-9-1-1 STEMI Coronary ALS 52

The Skeptics' Guide to EM

JUNE 24, 2017

By-standard CPR is started and EMS is called. 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. The Cochrane Collaboration updated their review on hypothermia for neuroprotection in adults after CPR in 2012.

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CPR Epinephrine ALS Paramedic 100

Don't Forget the Bubbles

DECEMBER 5, 2023

Reviewed by: Vicki Currie Article 5: Does occluding the femoral artery during neonatal CPR increase the likelihood of ROSC? (In Epinephrine was initially given to both groups after 5 minutes of chest compressions, this delay was based on a previous simulation study looking at length of time to site an UVC.

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Coronary Epinephrine CPR Emergency Department 111

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. 1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC).

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Defibrillator E-9-1-1 ALS Epinephrine 52

REBEL EM

DECEMBER 19, 2022

trying harder and longer knowing they are enrolled in this study) Use of two different models of defibrillators may negatively impact the internal validity of this pilot study Certain baseline characteristics were not balanced, such as: prehospital intubation and Epinephrine administration.

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