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Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.
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.
Looking at the workflow of a fresh post-op open heart surgery patient, as well as what to do when it devolves into cardiac tamponade, with (returning) guest Brendan Riordan, cardiothoracic ICU PA (@concernecus) at the University of Washington, and his NP colleague Kris Ramilo (@krsrml0). Audio quality was a bit dodgy in this one; sorry all!–eds.]
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.
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.,
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.
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]
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.
One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. 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.
On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. 8,9 Recently, monocyte distribution width (MDW) has shown promise in a large meta-analysis as a useful screening tool in the ED.
Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose. He ended up requiring a total of 13 grams of CaCl in the ED to maintain rhythm and hemodynamics until our dialysis colleagues could start dialysis in the ED. We could have also considered terbutaline (start at 0.25
For the presentation and ED evaluation of GBS, please see Part 1. Episode 112: Guillain-Barr Syndrome Part 2 ED treatment: IVIG and plasma exchange are the main treatment modalities. Have push dose epinephrine at the bedside as induction can remove sympathetic tone and result in a vagal episode.
A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. Left ventricular outflow tract obstruction in ICU patients. He has clinically deteriorated and required intubation.
PMID: 38857847 Bottom line: This before and after study demonstrates an association between early IM epinephrine and survival from cardiac arrest. PMID: 38857847 Bottom line: This before and after study demonstrates an association between early IM epinephrine and survival from cardiac arrest. Resuscitation. 2024 Aug;201:110266.
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