The Skeptics' Guide to EM

MARCH 2, 2019

They had a difficult time getting a definitive airway pre-hospital. There is no evidence for a patient-oriented benefit with epinephrine ( SGEM#238 ), other ACLS drugs ( SGEM#64 ), pre-hospital therapeutic hypothermia ( SGEM#54 , SGEM#183 ), or mechanical CPR ( SGEM#136 ). Key to survival is high-quality CPR and early defibrillation.

CPR 130

CPR Firefighter Paramedic Epinephrine 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

Dr. Smith's ECG Blog

JULY 25, 2024

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% Confirmation of sinus tachycardia should be easy to verify when the heart rate slows a little bit ( as the patient's condition improves ) — allowing clearer definition between the T and P waves.

Defibrillator 110

Defibrillator Coronary Epinephrine ACS 110

The Skeptics' Guide to EM

APRIL 4, 2020

This is being posted now because a high-definition video is available on YOUTUBE for those who could not attend or for those who want to watch this epic match again. You can see the original SGEM Xtra post from March 2019. It has more details about each issue we discussed and our slides.

Critical Care 130

Critical Care Epinephrine CPR Ambulance 130

REBEL EM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. 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.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

CPR 93

CPR STEMI Epinephrine ICU 93

EMDocs

OCTOBER 19, 2024

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] 2][3] Bacterial tracheitis should be suspected over croup if nebulized racemic epinephrine or steroids do not improve the clinical course. [2][3][8]

EMS 88

EMS E-9-1-1 Epinephrine OR 88

Dr. Smith's ECG Blog

MARCH 1, 2023

In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms. A "STEMI alert" was called and soon cancelled.

Allergic Reaction 52

Allergic Reaction E-9-1-1 Epinephrine Coronary 52

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. There is no definite evidence of acute ischemia. (ie, This is an important finding related to the etiology and treatment of these malignant arrhythmias — since by definition, PMVT with a prolonged QTc is classified as Torsades de Pointes ( and entails different treatment recommendations ).

Defibrillator 113

Defibrillator Coronary ALS STEMI 113

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) This dysregulation of vasodilation is associated with a mortality of close to 25%.

Epinephrine 71

Epinephrine ICU ALS OR 71

Dr. Smith's ECG Blog

OCTOBER 28, 2013

Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. The patient was taken for an angiogram and had an 80% LAD lesion, but it could not be definitely determined whether this was an acute thrombotic lesion or a chronic stable lesion. It was stented.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

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. 2 Death from hemoptysis is akin to drowning, so airway considerations usually take precedence over hemodynamic considerations.

E-9-1-1 52

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

Dr. Smith's ECG Blog

APRIL 29, 2020

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. The ultimate reason for the long QT was never definitively determined.

Epinephrine 52

Epinephrine Defibrillator Coronary Overdose 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. Of course this must be followed immediately with definitive therapies and potassium source control if possible.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Broome Docs

APRIL 6, 2023

As always the links to the papers are in the write up below and you definitely should read them rather than believe a couple of nerds amusing themselves upon the internet. Epinephrine metered-dose inhaler for pediatric croup. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Acad Emerg Med. Epub 2022 Dec 7.

Epinephrine 52

Epinephrine ED Emergency Department ALS 52

FOAMfrat

OCTOBER 1, 2023

We’re going to be discussing all things DROP FACTOR, including tubing and formula calculations! This is your warning. This is a MATH BLOG. Drop factors can be intimidating if we don’t have a good understanding of how med math works or what drop tubing is. That being said, today we will cover what drop factor tubing is. Infusion pumps are safer.

Epinephrine 52

Epinephrine 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. Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8

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. Of note, in the paper by Russotto et al., This means that if the patient was dead, critically hypoxic, or hemodynamically unstable, they were not included.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

My Paramedic Blog

FEBRUARY 21, 2015

That’s definitely not something I want to be awake for, in fact, it looks painful even when patients have it done under anesthetics. More epinephrine went in via IV. So the nurse drew up the medication as the doctor prepares for the procedure. We watched the ECG monitor as our patient goes into asystole, or flat line.

Epinephrine 52

Epinephrine CPR Paramedicine Paramedicine 52

REBEL EM

JANUARY 23, 2023

antibiotics, NSAIDs) Acute urticaria with angioedema or anaphylaxis provided that urticaria was still present after initial treatment and alleviation of anaphylaxis symptoms. Exclusion: Presented with acute anaphylaxis, and their acute anaphylactic symptoms had not yet been treated. The mean time spent at a treatment center in hours was 1.7

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 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. I had a reputation as a tough preceptor. I was the one that people either sought out because they wanted the challenge; or the one that they avoided. Didn’t give it; just took it out of the box.

Paramedic 52

Paramedic OR EMT EMT 52

Dr. Smith's ECG Blog

JANUARY 19, 2020

At about 30 minutes after presentation, the patient had acceptable vital signs with the TVP and low dose epinephrine drip. The cath lab was activated. The interventionalists insisted that the ECGs did not meet STEMI criteria and cancelled the activation, stating that they would consider urgent cath after further stabilization.

E-9-1-1 52

E-9-1-1 STEMI ED EMS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58). 2 The astute paramedic recognized this possibility and announced a CODE STEMI. 2 The astute paramedic recognized this possibility and announced a CODE STEMI.

Coronary 40

Coronary ACS ALS STEMI 40

FOAMfrat

SEPTEMBER 19, 2024

is positive thanks to the widespread availability of antivenom, relatively short transport times to definitive care, and the U.S.'s Young adult males between the ages of 25-34 incur the largest number of snake bites, and a significant percentage of snake bites occur while a snake (captive or wild) is being intentionally handled.

Emergency Department 95

Emergency Department Epinephrine OR Plasma 95

The Skeptics' Guide to EM

MARCH 5, 2022

The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. They wonder how strong the evidence is for much of what we do in emergency medicine. Background: There are many things in medicine that could be considered myth or dogma. We have covered some of these over the 10 years.

Epinephrine 100

Epinephrine ALS OR 100

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.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

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.

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105