Core EM

JANUARY 25, 2024

1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. Door-to-block time: prioritizing acute pain management for femoral fractures in the ED. A new frontier in pelvic fracture pain control in the ED: Successful use of the pericapsular nerve group (PENG) block.

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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. JAMA Sept 2021.

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Core EM

OCTOBER 16, 2024

In: Marx J, ed. In: Wolfson A, ed. 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%

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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% The patient was brought to the ED and had this ECG recorded: What do you think? He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. sodium bicarbonate.

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EMDocs

JANUARY 8, 2024

This post will focus on the key parts of the guideline that affect ED evaluation and management. Vasopressor medications during cardiac arrest We recommend that epinephrine be administered for patients in cardiac arrest. It is reasonable to administer epinephrine 1 mg every 3 to 5 minutes for cardiac arrest. COR 1, LOE B-R.

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ESO

DECEMBER 19, 2024

Read the 2024 ESO EMS Index Read the 2024 ESO Fire Service Index Post-Resuscitation Epinephrine Vs. Norepinephrine in Cardiac Arrest Released in May 2024 Epinephrine and norepinephrine are both commonly used as prehospital vasopressors in the United States.

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Epinephrine Firefighter First Responder Public Safety 103

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Case: A 6-month-old boy presents to the emergency department (ED) with three days of worsening cough, cold symptoms, and fever. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU). Pediatric Crit Care Med. Parents note that he has been progressively more tired and difficult to arouse.

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The Skeptics' Guide to EM

JANUARY 9, 2021

Case: During a busy emergency department (ED) shift the paramedic phone rings. This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ).

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Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. 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.

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EMDocs

APRIL 10, 2024

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] doi:10.1007/BF03161199 Olson K, Smollin C, eds.

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ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

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REBEL EM

SEPTEMBER 13, 2023

In: UptoDate, Feldweg AM (ed.) Angioedema in the Emergency Department: An Evidence Based Review. Emergency Medicine Practice. EBMedicine.net. 2012; 14(11). Zuraw et al. An overview of angioedema: Clinical features, diagnosis, and management. UpToDate, Waltham, MA. Clinical practice. Hereditary angioedema. N Engl J Med. 2008;359(10):1027-1036.

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Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Here is the initial ED ECG. What do you think? Rhythm : Residents asked me why it is not VT.

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Critical Care Scenarios

NOVEMBER 29, 2020

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.] Adding an inotrope can be somewhat diagnostic, as patients with mere myocardial stunning will improve, whereas patients with tamponade will generally have little response.*

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REBEL EM

JANUARY 23, 2023

Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 7 (5.5%) patients in the IV cetirizine group returned to any ED or clinic within 48 hours compared to 19 (14.1%) in the IV diphenhydramine group; P=0.02

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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.,

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Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. 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%

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Allergic Reaction Plasma ED Epinephrine 100

Dr. Smith's ECG Blog

MARCH 1, 2023

Sent by anonymous, written by Pendell Meyers A man in his late 40s presented to the ED with concern for allergic reaction after accidentally eating a potential allergen, then developing an itchy full body rash and diarrhea. In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis.

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The Overrun Podcast

MARCH 28, 2021

Ed and Dan sit down with Dr. Peter Antevy and talk about how we can do better with pediatric arrests. For most places in EMS, how we treat cardiac arrests in adults is drastically different than how we do it in pediatric patients. And the results show it.

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ACEP Now

DECEMBER 6, 2024

Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga., Overall, cardiac arrest in the setting of coronary vasospasm is thought to be relatively uncommon.

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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. TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit ( REBEL EM review ).

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E-9-1-1 Epinephrine ED ALS 52

Silk City Blog

DECEMBER 6, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit (REBEL EM review). Am J Emerg Med.

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Handtevy

DECEMBER 3, 2021

I’ll never forget that Sunday morning in the ED when I opened up the printer tray to grab a clean 8.5” I paced in the ED racking my brain on how to overcome the difficulties of medication dosing during high stress moments, until it hit me like a ton of bricks, “Just do what Bob Hickey used to do.”

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Don't Forget the Bubbles

MAY 8, 2024

Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Use of Initial Endotracheal versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database. Parasitic infections: what do paediatricians need to know?

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Broome Docs

APRIL 6, 2023

PMID: 36538321 Am I the only one thinking that this illicit drug additive seems like a really good antidote to the methamphetamine toxidromes that we are constantly managing in the ED? Epinephrine metered-dose inhaler for pediatric croup. Acad Emerg Med. 2023 Feb;30(2):144-146. doi: 10.1111/acem.14616. Epub 2022 Dec 7.

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Epinephrine ED Emergency Department ALS 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Lange RA, Cigarroa RG, Flores ED, et al. Esmolol in the management of epinephrine- and cocaine-induced cardiovascular toxicity. Rangel C, Shu RG, Lazar LD, Vittinghoff E, Hsue PY, Marcus GM. Beta-blockers for chest pain associated with recent cocaine use. Arch Intern Med;170(10):874-9. Ann Int Med 1990;112(12):897-903.

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ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. He was found by bystanders after he collapsed and 911 was called.

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Dr. Smith's ECG Blog

APRIL 29, 2020

She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. ECG #4 — This is the 3rd ECG that was done in this case ( obtained ~1 hour after arrival in the ED ). She was never defibrillated.

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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. She arrived in the ED 37 minutes after 911 was called, with continuing CPR.

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Dr. Smith's ECG Blog

NOVEMBER 9, 2018

External pacing was attempted but not tolerated and, because the patient was only mildly hypoperfused, she was transported to the ED without further intervention. Here is the first ED ECG: What are you seeing? Chronotropic support with Isoproterenol, Epinephrine, or Dopamine to increase ventricular escape rate.

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Dr. Smith's ECG Blog

JANUARY 19, 2020

On arrival in the ED, she was profoundly hypotensive, nearly obtunded, and bradycardic. At about 30 minutes after presentation, the patient had acceptable vital signs with the TVP and low dose epinephrine drip. The ED team again pointed out the evidence of inferoposterior OMI, this time by the modified Sgarbossa criteria.

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EMS 12-Lead

MAY 15, 2024

Epinephrine administered intravenously. They administered 10 mcg of push-dose epinephrine. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Atropine and further doses of epinephrine were not administered. Several learning points here.

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Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. Folland ED, et al. In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. In the cath lab, the patient’s blood pressure remained low. The mean MAP for these patients was 81 +/- 13.

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Coronary ACS ALS STEMI 40

EMS 12-Lead

MARCH 30, 2024

After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). On ED arrival ROSC is achieved. Two paramedics are in the rear of the ambulance managing resuscitation (another crew had arrived and provided support with a driver). Junctional Rhythm, occasional PAC's, and artifact.

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Core EM

JANUARY 25, 2024

Three children (2.1%) had true hyperkalemia: one had known chronic renal failure and was referred to the ED due to concern for electrolyte abnormalities; the other 2 patients had diabetic ketoacidosis (DKA).

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ALiEM

NOVEMBER 29, 2023

Xylazine is an alpha-2 agonist similar to clonidine that inhibits the release of norepinephrine and epinephrine resulting in decreased vascular tone and heart rate [4]. Xylazine use is also associated with severe necrotic skin ulcerations and superimposed infection [3, 4]. How does xylazine toxicity present?

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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.*

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