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. ST depression will not always be present in 9/12 leads — as is seen in Figure-1.

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Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Vittinghoff, E. Metoprolol and atenolol are overwhelmingly beta-1 cardioselective. Beta-1 blockade decreases inotropy and chronotropy and has no vasoconstrictive effects. The prohibition against beta blockade in cocaine toxicity, causing "unopposed alpha" stimulation, needs to be re-examined. is intuitive, and not surprising.

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NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. 1] Table from Hamam et al. 9] Figure from Clemency et al. 1] References 1. minutes versus 5.4 minutes). [5] vs 19.7%) access (figure below).

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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. Another ECG was obtained during pacing: Mostly paced rhythm with PVCs (#3, #6, #9, #12). Figure-1: ECG #1 — recorded by EMS on the scene ( See text ). mm STE with 9.5

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ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 De Backer D, Creteur J, Silva E, Vincent JL.

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REBEL EM

SEPTEMBER 26, 2022

2020;71(1):235-246. Plt 37×10^9/L and 40×10^9/L, SOC and TEG, respectively) All patients enrolled had an upper endoscopy and verified the source of bleeding. Article: Kumar M et al. Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial.

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REBEL EM

JULY 18, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. 2013 Sep;31(9):1389-92. PMID: 33612282 Janapala RN, Tran QK, Patel J, Mehta E, Pourmand A. Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al.

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FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Recommendations : 1. Why is Physiologic Optimization Important?

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NAEMSP

APRIL 19, 2023

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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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. Here they are: Learning Points: 1. Type 1 and 2 Myocardial Infarction and Myocardial Injury: Clinical Transition to High-Sensitivity Cardiac Troponin I. Am J Med [Internet] 2017;130(12):1431–9.e4.

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REBEL EM

JANUARY 23, 2023

Patients were randomized in a 1:1 ratio. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. 2005 Sep;116(3):643-9. PMID: 32653333 What They Did Multi-center, double-blind, randomized, phase 3 clinical trial with a parallel-group, active-controlled, non-inferiority design. 2010 Apr;65(4):459-66.

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ACEP Now

NOVEMBER 14, 2023

1 However, it is important to understand that death from hemoptysis is almost always due to hypoxia or asphyxiation (blood impedes gas exchange in the lungs, typically because of bleeding from high-pressure bronchial arteries into the lungs) as opposed to hemodynamic instability. 2021;42(1):145-159. Life-threatening hemoptysis.

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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. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):1–9.

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ECG Medical Training

DECEMBER 4, 2016

Cardiac Care Show – Episode #1: Mechanical CPR Hello, and welcome to the Cardiac Care Show. Start an IV and give epinephrine? References Levy M, Yost D, Walker RG, Scheunemann E, Mendive SR. doi:10.1016/s0140-6736(14)61886-9. Rubertsson S, Lindgren E, Smekal D, et al. 2014;311(1):53. 2012;20(1):39.

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EMDocs

JANUARY 4, 2024

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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EMDocs

DECEMBER 18, 2023

This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). 1 Since 2021, attempts to identify a single screening tool with optimal sensitivity and specificity to predict which patients will develop sepsis or septic shock have been ongoing.

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Don't Forget the Bubbles

MAY 8, 2024

You will find the list is broken down into four sections: 1.Reviews 2024 Apr 9. Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9. 2024 Apr 9:S0890-8567(24)00184-9. 2024 Apr 9.

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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). 2018;13(9):e0204169.

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EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

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EMDocs

OCTOBER 29, 2024

Chu CK, Delia E, Mograder A, Dwyer EM. 2017;45(1):12-20. 2015;7(9):E365-E369. 2018;12(1). m/s)—problematic and elevated > 50 mm Hg (2.5 J Saudi Hear Assoc. 2018;30(4):336. doi:10.1016/J.JSHA.2018.07.001 2018.07.001 Sherrid M V., J Am Coll Cardiol. 1993;22(3):816-825. Anaesth Intensive Care. J Thorac Dis.

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Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. Today's patient unfortunately developed PEA ( P ulseless E lectrical A ctivity ) arrest shortly after arrival of the medic team. Not a shockable rhythm. They laid her on the floor and called 911. Shortly thereafter, pulses were lost.

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EMDocs

JANUARY 22, 2025

1 Most heroin in the United States actually contains fentanyl and fentanyl analogs. Naloxone reverses the analgesic, respiratory, sedative , and miotic e ffects of opioids. 6 Image 1: Structure of naloxone. Published 2023 Sep 1. doi:10.15585/mmwr.mm7235a3 Park JN, Rashidi E, Foti K, Zoorob M, Sherman S, Alexander GC.

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This Podcast Will Kill You

JANUARY 14, 2025

Our allergy treatment toolkit includes an impressive suite of tools, and in the second episode of our two-part series on allergies, we focus on three in particular: antihistamine medications, allergy shots, and the epinephrine auto-injector (aka the EpiPen). “Epinephrine: a short history.” Then this is the episode for you.

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EMDocs

MARCH 18, 2025

Episode 116: Massive Hemoptysis Definition: Hemoptysis is expectoration of blood from the respiratory tract; ranges from mild with small streaks of blood to cardiopulmonary compromise (1-5). Massive hemoptysis: no clear definition, ranges from 50 mL in a single expectoration to 100 mL in 24 hours to over 1 L in 48 hours.

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ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. Figure 1: The EMS rhythm strip. Type 3 is indicated by J point and ST elevation < 1 mm.

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