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Neurogenic Shock in Children

Pediatric EM Morsels

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Both norepinephrine and epinephrine can be used. 2011;46(9):1771. J Pediatr Surg. 5 th Edition.

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Post-Tonsillectomy Hemorrhage: ReBaked Morsel

Pediatric EM Morsels

Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage. Tranexamic Acid (TXA) IV TXA 15 mg/kg for a child 1 g for adult (that’s right…this isn’t just a presentation seen in children.

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The Broselow-Luten System

Pediatric EM Morsels

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. Prehosp Emerg Care. Patient safety in the pediatric emergency care setting. 2020;13(1):9.

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ToxCard: Bupropion

EMDocs

1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). QRS > 100 msec can give sodium bicarbonate 1-2 mEq/kg IV boluses. 9-12 Do not use this prophylactically in bupropion overdoses. Other Norepinephrine or epinephrine are preferred vasopressors when needed.

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Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG , central vein catheter and intra-arterial catheter (A-line) is warranted.

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Calcium in Out-of-Hospital Cardiac Arrest

NAEMSP

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g. References: 1. He is found to be in ventricular fibrillation (VF). Ramazan, K.,

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What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

ACEP Now

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). 2018;13(9):e0204169.