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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CPR Paramedic Ambulance Epinephrine 312

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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Epinephrine ED OR 246

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.

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Epinephrine Emergency Department ALS Operating Room 98

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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Epinephrine ED Emergency Department Ambulance 246

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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Epinephrine Critical Care Life Support Emergency Department 100

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%

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% 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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Defibrillator Coronary Epinephrine ACS 125

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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Epinephrine Defibrillator Coronary CPR 98

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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CPR ICU Critical Care Epinephrine 130

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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Naloxone Overdose Epinephrine ALS 169

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

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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EMS Emergency Medical Services CPR Critical Care 130

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

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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E-9-1-1 Plasma Epinephrine Life Support 111

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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Defibrillator OR ALS Epinephrine 98

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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Defibrillator Coronary Epinephrine CPR 133

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.

Frozen Plasma 101

Frozen Plasma Allergic Reaction FFP Plasma 101

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.*

ICU 100

ICU Epinephrine OR ED 100

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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CPR STEMI Epinephrine ICU 114

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). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. It is unclear how long he was down.

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Defibrillator CPR Epinephrine Life Support 108

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

Allergic Reaction 52

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

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%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

ACEP Now

NOVEMBER 6, 2024

A gravid woman presents to your emergency department (ED). mg/kg IV epinephrine, or 0.05–0.1 Before you can obtain any history, she gives birth in your waiting room. The neonate is apneic and has a heart rate of 48. How do you stabilize this patient? Neonatal resuscitation is common; 10 percent of the four million newborns in the U.S.

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Epinephrine Emergency Department EMS OR 98

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

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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Epinephrine Paramedic ED EMS 52

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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Coronary Life Support ALS Emergency Department 98

EMDocs

OCTOBER 19, 2024

2][3] Bacterial tracheitis should be suspected over croup if nebulized racemic epinephrine or steroids do not improve the clinical course. [2][3][8] A 6-year-old girl presents to the ED with 1 day of fevers up to 104.1°F 2] Antibiotics Antibacterial management should be prompt and include broad-spectrum coverage, including MRSA. [2]

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EMS E-9-1-1 Epinephrine OR 109

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 ).

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

EMDocs

MAY 26, 2023

But what about the patient who is agitated, and is a potential danger to themselves or to the ED staff? Avoid Trying to Reason With Them When agitated, a child’s prefrontal cortex is suppressed by the cortisol and epinephrine induced fight-or-flight reaction. Do we Redirect?

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Emergency Medical Services Emergency Department OR ED 97

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient was administered thrombolytics and shortly after the lytics were administered, the systolic blood pressure rose to about 80mmHg with ongoing epinephrine infusion. Those who make it to the ED usually have transient occlusions with reperfusion. Thrombolytics can be life saving in this situation.

Coronary 129

Coronary ACS Emergency Department Epinephrine 129

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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Epinephrine EMS ED ALS 40

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.”

Epinephrine 52

Epinephrine EMS ED OR 52

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.

Epinephrine 52

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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E-9-1-1 Epinephrine Coronary Overdose 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. 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.

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. Bottom Line: Hyperkalemia is an increasingly common ED diagnosis that must not be missed.

Epinephrine 52

Epinephrine ICU Coronary EMS 52