The Skeptics' Guide to EM

SEPTEMBER 29, 2018

Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado.

BLS 130

BLS Defibrillator Critical Care CPR 130

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.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Guest Skeptic: Dr. Neil Dasgupta is an emergency physician and ED intensivist from Long Island, NY, and currently an assistant clinical professor and Director of Emergency Critical Care […] The post SGEM#350: How Did I Get Epi Alone? Epinephrine is provided and you quickly place an advanced airway.

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

Critical Care Scenarios

MAY 31, 2020

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. To hemodynamically manage RV failure without worsening RV afterload, consider the Rule of 8s cocktail:* Epinephrine.08 an overly high FiO2 will tend to worsen V/Q matching.*

Critical Care 100

Critical Care Epinephrine ED ALS 100

The Skeptics' Guide to EM

APRIL 4, 2020

We went four rounds punching and counter punching arguments about critical care controversies. We both agree that the patient deserves the best care, based on the best evidence. It is an example of mixing education and entertainment for some great knowledge translation. The REBEL took the fight to the Skeptic.

Critical Care 130

Critical Care Epinephrine CPR Ambulance 130

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Pediatric Crit Care Med. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).

CPR 130

CPR ICU Critical Care Epinephrine 130

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.,

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Validation study done in Italy.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

Critical Care Scenarios

DECEMBER 7, 2022

Epinephrine at lower doses is a good second line, providing inotropic support for the RV without much impact on PVR. Click here to claim your CME credit! Find us on Patreon here! Buy your merch here! Avoid intubation if at all possible, as this can easily provoke cardiovascular collapse. . Place an arterial line early.

ICU 100

ICU Critical Care Epinephrine OR 100

REBEL EM

APRIL 29, 2024

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. If you are not familiar with this term, it’s the act of rapidly trying to place a central line (usually femoral), placing the needle for access over strict sterile precautions.

Epinephrine 105

Epinephrine ALS Critical Care Emergency Department 105

Critical Care Scenarios

NOVEMBER 29, 2020

Point-of-care TTE is always difficult in these patients, due to their windows being obscured by dressings; the apical 4-chamber will often be the most useful view. . * Be aggressive with fluid resuscitation and consider epinephrine up to 0.06–0.08 Audio quality was a bit dodgy in this one; sorry all!–eds.] vancomycin).

ICU 100

ICU Epinephrine OR ED 100

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). 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.

Defibrillator 110

Defibrillator CPR Epinephrine Life Support 110

Handtevy

MARCH 14, 2018

If we remove these decades old requirements we can begin to reshape human behavior at the point of care, where it matters most. All patients were treated on scene and epinephrine was administered within 5 minutes of arrival on scene. What changed? Confidence of the providers leveled up with that of the adult patient.

CPR 52

CPR Epinephrine Critical Care EMS 52

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 6 In one study, almost all patients who went on to develop seizures had tachycardia prior to the seizure. EMIT II immunoassay).

Overdose 94

Overdose E-9-1-1 ALS Emergency Department 94

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. 2020), but IV Calcium is still used routinely in some cases in the critical care setting, such as congenital heart disease. 2021), and AHA guidelines also maintain this use (Panchal, et al., mEq/L (OR: 51.11; 95% CI: 3.12−1639.16;

E-9-1-1 52

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

ECG & Echo Learning

OCTOBER 2, 2022

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. J Intensive Care Med 2021; 36:101. Crit Care Med 2003; 31:1659.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. The Dublin cardiac arrest registry: temporal improvement in survival from out-of-hospital cardiac arrest reflects improved pre-hospital emergency care. A 67-year-old man presents to the emergency department (ED) in cardiac arrest. N Engl J Med.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

AAEM RSA

AUGUST 27, 2020

There was no blinding for the direct care providers, but neurologic prognostication was performed by blinded individuals. However, the decade since the original Hypothermia after Cardiac Arrest trial had seen significant advances in pre-hospital, emergency department, and critical care that may have contributed to these outcomes.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Here are the American Heart Association Guidelines: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 10.1: Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? There is also bradycardia. Is 40 mEq too much?

STEMI 52

STEMI Plasma Defibrillator OR 52

The Skeptics' Guide to EM

NOVEMBER 30, 2024

Guest Skeptic: Missy Carter is a PA currently practicing in critical care after having attended the University of Washington's MEDEX program. 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.

Epinephrine 251

Epinephrine OR CPR Paramedic 251

Critical Care Scenarios

JANUARY 8, 2025

If you’re above this DBP, just skip epinephrine, which will probably merely be toxic (ie promoting arrhythmias). * Finally, if it’s truly just vasoplegia, consider other moves, such as adding vasopressin/steroids (an evidence-based practice) or high-dose epinephrine (5 mg epinephrine).

Epinephrine 214

Epinephrine Defibrillator Coronary ED 214

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 98

E-9-1-1 ICU Epinephrine EMS 98

EMDocs

MARCH 18, 2025

Prior to current therapies, mortality rates ranged between 50-100%. More current numbers suggest rate between 6-38% (1-3,10-15). Etiologies: Any factor associated with airway or pulmonary parenchymal damage or increased bleeding increases risk of hemoptysis. Tuberculosis is most common cause worldwide. Imaging: Start with bedside chest x-ray.

E-9-1-1 82

E-9-1-1 FFP Critical Care ALS 82

FOAMfrat

NOVEMBER 25, 2024

Regardless, of whether you are caring for female one or two, we should be aware that both cases are immensely complicated to manage and require our most valiant efforts. AFEs are rare, and little is known about the etiology of their development or the pathophysiology of their damage. But how do we manage them?

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105

FOAMfrat

DECEMBER 4, 2024

Fast forward a few years, maybe a critical care class or a few Studio modules, and now we’ve learned that there’s a whole world of vasopressors, inotropes, inopressors, and inodilators out there. Why do we care about this number though? You’re me, and you’re in paramedic school, in the thick of the cardiology section.

Coronary 64

Coronary STEMI Epinephrine Critical Care 64