The Skeptics' Guide to EM

APRIL 4, 2020

Date: April 4th, 2020 It has been just over a year since Dr. Salim Razaie (REBEL EM) and I stepped into the ring for a boxing matched theme debate in Sydney, Australia. Date: April 4th, 2020 It has been just over a year since Dr. Salim Razaie ( REBEL EM) and I stepped into the ring for a boxing matched theme debate in Sydney, Australia.

Critical Care 130

Critical Care Epinephrine CPR Ambulance 130

Dr. Smith's ECG Blog

JULY 25, 2024

EMS arrived and found him in Ventricular Fibrillation (VF). 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. They started CPR. He was defibrillated into VT. sodium bicarbonate.

Defibrillator 123

Defibrillator Coronary Epinephrine ACS 123

REBEL EM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. Rezaie, MD (Twitter/X: @srrezaie ) The post Don’t Forget About the IO in the Critically Ill Patient appeared first on REBEL EM - Emergency Medicine Blog.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

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

REBEL EM

NOVEMBER 6, 2023

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) REFERENCES: Hiruy A, et al.

ICU 71

ICU Epinephrine ALS OR 71

REBEL EM

DECEMBER 19, 2022

At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it. Within the United States, due to paramedic shortages, this dual-medic setup does not exist in many EMS systems. That write up was for the DOSE-VF pilot trial done in March 2020 and can be found here.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

Dr. Smith's ECG Blog

APRIL 29, 2020

EMS arrived and found her in a wide complex PEA rhythm. 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. CPR was started immediately.

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

REBEL EM

JANUARY 23, 2023

Noninferiority trials, covered here on REBEL EM , are helpful when the experimental treatment offers a distinct advantage over the standard treatment. Rezaie, MD (Twitter: @srrezaie ) The post Cetirizine Vs Diphenhydramine For the Treatment of Acute Urticaria in the ED appeared first on REBEL EM - Emergency Medicine Blog. Schaefer P.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

Dr. Smith's ECG Blog

JANUARY 19, 2020

Her family called EMS and EMS recorded hypotension and this ECG: What do you think? At about 30 minutes after presentation, the patient had acceptable vital signs with the TVP and low dose epinephrine drip. Figure-1: ECG #1 — recorded by EMS on the scene ( See text ). This is an obvious inferoposterior OMI.

E-9-1-1 52

E-9-1-1 STEMI ED EMS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension. Answer below in the still shot.

Coronary 40

Coronary ACS ALS STEMI 40

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. 2][3] Definitive diagnosis is made by laryngoscopy or bronchoscopy showing normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates. [3] A 6-year-old girl presents to the ED with 1 day of fevers up to 104.1°F

EMS 111

EMS E-9-1-1 Epinephrine OR 111

The Skeptics' Guide to EM

MARCH 2, 2019

Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient. They had a difficult time getting a definitive airway pre-hospital. It required multiple attempts which caused several prolonged interruptions in CPR. Background: We have covered OHCA many times on the SGEM.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. Epinephrine infusion was begun. There is no definite evidence of acute ischemia. (ie, Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.

Defibrillator 130

Defibrillator Coronary ALS STEMI 130

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. Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. He had been given 3 grams Ca gluconate by EMS. After ROSC achieved: Sinus rhythm. QRS much more narrow.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

The Overrun

APRIL 19, 2021

The call involved a sick patient where the student, who was on the verge of going to boards, pulled out the wrong concentration of epinephrine. As they told the story, a couple conversations with the director of EMS, the medical director, and the clinical management, and the student was gone. But not in this case. 3) Anxiety.

Paramedic 52

Paramedic EMT EMT OR 52

REBEL EM

SEPTEMBER 26, 2022

Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease. It’s unclear whether interventions such as cauterization, clip placement, epinephrine injection, etc.,

FFP 52

FFP E-9-1-1 ICU ALS 52

FOAMfrat

OCTOBER 20, 2023

Likely due to different definitions for hypotension and adverse/major critical events, but the numbers remain higher than we would ever like — Kinda scary when you think about it. Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. Now, what is the resuscitation end goal?

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

The Skeptics' Guide to EM

NOVEMBER 30, 2024

Case: You’re doing a ride along with your local emergency medical service (EMS) crews and responding to an out-of-hospital cardiac arrest (OHCA). 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 249

Epinephrine OR CPR Paramedic 249

Core EM

APRIL 23, 2025

Definition: Refractory Ventricular Arrhythmias Persistent ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) despite 3 shocks, appropriate CPR, vasopressors, and anti-arrhythmics. Administer epinephrine every 35 minutes. Linked with extremely poor outcomes: survival to discharge ~212%. N Engl J Med. Resuscitation.

Defibrillator 130

Defibrillator CPR ALS Epinephrine 130

EMDocs

APRIL 3, 2025

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, APD, Geisinger Wyoming Valley, PA); Christian Daniello, MD (Staff Physician, Geisinger Wyoming Valley) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations. Thats 18 beats per minute.

Epinephrine 101

Epinephrine EMS OR ED 101

FOAMfrat

NOVEMBER 25, 2024

Earlier in the summer, I wrote a blog discussing the challenges, intricacies, and educational pitfalls of postpartum hemorrhage in EMS. In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. I even know of cases that my colleagues have managed!

Epinephrine 106

Epinephrine CPR Operating Room Plasma 106