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

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. Chest compression fraction.

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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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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

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

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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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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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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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 98

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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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

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. The focus should not be on figuring out the child’s weight, or determining the dose or mathematical equations. What changed?

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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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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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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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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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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. Thinking about the paramedic vs. EMT debate?

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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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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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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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Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device.

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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. Where Else do EMTs Work?

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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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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. mEq/L (OR: 51.11; 95% CI: 3.12−1639.16;

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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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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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Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. With ventilations and epinephrine, she regained a pulse. A middle-age woman with h/o hypertension was found down by her husband. She was never seen to be in ventricular fibrillation and was never defibrillated. BP gradually rose. Kurkciyan et al.

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My Paramedic Blog

FEBRUARY 21, 2015

Doctor: “Start CPR. More epinephrine went in via IV. The shock was delivered, we watched as our patient’s back arched slightly and then sank back onto the bed. We watched the ECG monitor as our patient goes into asystole, or flat line. We all knew things weren’t quite right. Don’t die on me! To wake up.

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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. 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. 3–8 Shi et al.

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Dr. Smith's ECG Blog

APRIL 8, 2016

We could not resuscitate her, but we did have excellent perfusion with LUCAS CPR, such that pulse oximetry had excellent waveform and 100% saturations, end tidal CO2 was 35, and cerebral perfusion monitoring was near normal throughout the attempted resuscitation. Here is his ED ECG: There is obvious infero-posterior STEMI. Is 40 mEq too much?

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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

With millions of journal articles published yearly, it is impossible to keep up. Our team have scoured the literature, so you don’t have to… or it might spark an interest to go and have a look at the full article. A very Merry Christmas from the BW team, and all the Best Wishes for 2024! Br J Gen Pract. 2023 Oct 26;73(736):e850-e857.

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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). 2011;13(8):1157–65. N Engl J Med.

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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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The Skeptics' Guide to EM

NOVEMBER 30, 2024

After starting cardiopulmonary resuscitation (CPR), you note pulseless electrical activity (PEA) on the monitor. The paramedic is trying to get intravenous (IV) access to give epinephrine per the protocol. Epinephrine has long been a cornerstone in the management of OHCA. Reference: Couper et al.

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FOAMfrat

NOVEMBER 25, 2024

Epidemiology Amniotic fluid embolism (AFE) is an incredibly rare yet catastrophic pathology during which fetal debris and/or amniotic fluid enters the maternal central circulation in the third trimester of pregnancy or, most commonly, during the labor process. Regardless, she complains of sudden and severe shortness of breath.

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