The Skeptics' Guide to EM

OCTOBER 31, 2020

She writes a blog called The Procedural Pause for Emergency Medicine News and is the lead content editor and director for the video series soon to be included in Roberts & Hedges ‘ Clinical Procedures in Emergency Medicine. Epinephrine containing local anesthetics can be used without the fear of an appendage falling off. *

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Epinephrine Emergency Department EMS ALS 130

Pediatric EM Morsels

JULY 19, 2024

If bleeding, the only lab that is needed in the Emergency Department is a type and cross. Soak the gauze with epinephrine (1:10,000) or TXA (our THIRD route of administration) Apply pressure laterally to the tonsillar fossa with the gauze covered Magill forceps. CBC, coagulation panels, von Willebrand factor etc are less useful.

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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? each year will require at least some intervention. ET tube size should be 2.5

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Epinephrine Emergency Department EMS OR 98

REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 Angioedema in the Emergency Department: An Evidence Based Review. Emergency Medicine Practice. of people who take NSAIDs ( Nzeako 2010 ).

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Frozen Plasma Allergic Reaction FFP Plasma 105

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. 1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353. Pediatric Crit Care Med.

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REBEL EM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. Ong MEH, Chan YH, Oh JJ, et al.

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ALS Epinephrine Critical Care Emergency Department 105

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]. Opioid overdoses involving xylazine in emergency department patients: a multicenter study. How does xylazine toxicity present? 2022;14(8):e28160.

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Naloxone Overdose ALS Epinephrine 169

Pediatric EM Morsels

OCTOBER 27, 2023

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. Int J Emerg Med. Use of the Broselow tape in a Mexican emergency department.

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The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services at Tacoma Community College. Case: During a busy emergency department (ED) shift the paramedic phone rings.

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EMS Emergency Medical Services CPR Critical Care 130

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. On arrival in the emergency department, invasive blood pressure was 35/15mmHg and the patient was in profound cardiogenic shock with severe confusion secondary to brain hypoperfusion. The below ECG (ECG #4) was recorded.

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Coronary ACS Emergency Department Defibrillator 125

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. We were trying to answer the question: Do all patients presenting to the emergency department with chest pain need to be placed on cardiac monitoring or could some be safely removed?

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Epinephrine Emergency Department EMS ALS 130

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. Adult cardiac arrest in the emergency department – A Swedish cohort study.

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Core EM

JANUARY 25, 2024

Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department.

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The Skeptics' Guide to EM

MARCH 2, 2019

JAMA 2018 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a physician assistant practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. They had a difficult time getting a definitive airway pre-hospital.

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The Skeptics' Guide to EM

SEPTEMBER 16, 2017

Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will not work.

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Epinephrine ALS Emergency Department EMS 130

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). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. Per EMS he was very cold to touch.

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Defibrillator CPR Epinephrine Life Support 84

The Skeptics' Guide to EM

APRIL 20, 2019

Case: A 52-year-old man presents to the emergency department via EMS after a motor vehicle collision while driving home from the city. It is 2am Saturday morning and the night shift has been busy. You suspect he has been drinking. Background: We have busted many myths on the SGEM over the years.

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Epinephrine ALS Emergency Department EMS 100

Don't Forget the Bubbles

MAY 8, 2024

A silent scream in the pediatric emergency department: child abuse and neglect. Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland. Akkaya B et al. Eur J Pediatr. 2024 Apr 13. Yager H et al.

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E-9-1-1 ALS Emergency Department Epinephrine 69

EMDocs

MAY 26, 2023

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. Emerg Med Clin North Am. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. Deaths due to physical restraint.

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Emergency Medical Services Emergency Department OR ED 76

REBEL EM

JANUARY 23, 2023

Multicenter study of emergency department visits for insect sting allergies. Multicenter study of emergency department visits for food allergies. 2006) “Management of acute allergic reactions and anaphylaxis in the Emergency Department between 1993-2003,” Journal of Allergy and Clinical Immunology , 117(2).

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

NCOAE

NOVEMBER 13, 2021

Basic anatomy and physiology, what causes common diseases like diabetes and asthma, and how to treat emergencies associated with them. Depending on the state, EMTs are authorized to administer 10 to 20 different medications, including epinephrine for an anaphylactic reaction, narcan for an overdose, or albuterol for an asthma attack.

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EMT EMT Emergency Medical Technician Ambulance Driver 52

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. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds. in the TXA group versus 41.3%

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E-9-1-1 Epinephrine ED ALS 52

Broome Docs

APRIL 6, 2023

A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. Epinephrine metered-dose inhaler for pediatric croup. Acad Emerg Med. 2010 Oct 5;182(14):1527-32. doi: 10.1503/cmaj.091974. Epub 2010 Aug 23. 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

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. What do you think?

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STEMI ACS Coronary Defibrillator 52

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. The emergency department evaluation and management of massive hemoptysis. Am J Emerg Med. 13,14 The typical regimen is 500 mg three times daily. References Deshwal H, Sinha A, Mehta AC.

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

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department. Turkish Journal of Emergency Medicine, 22 , 67-74. Wongtanasarasin, W., Namsongwong, N.,

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Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. He arrived in the emergency department hemodynamically stable. This young male had ventricular fibrillation during a triathlon. On his bib it stated that he had a congenital heart disorder. His initial ECG is shown here.

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ACS Defibrillator Epinephrine STEMI 52

FOAMfrat

OCTOBER 20, 2023

Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Intern Emerg Med. Acad Emerg Med. Resuscitation. 2021 May;162:403-411. 2021.02.039.

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FOAMfrat

SEPTEMBER 19, 2024

These side effects do not contraindicate antivenom administration and can be treated with antihistamines and epinephrine. Hypotension and anaphylaxis should be treated with epinephrine following your local guidelines. Rattlesnake Envenomation Treatment & Management: Prehospital Care, Emergency Department Care, Consultations.”

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ACEP Now

OCTOBER 28, 2024

Holy Foley A Rare Case of Iatrogenic Obstruction by Adam Heilmann, MD; Jessica Pelletier, DO; Jennifer Reyes Lin, MD, MPH Our patient is a 33-year-old male with spastic quadriparesis due to cerebral palsy with chronic indwelling suprapubic catheter (SPC) who presented to the emergency department (ED) due to concern for Foley catheter obstruction.

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Emergency Department Defibrillator Epinephrine EMS 52

AAEM RSA

AUGUST 27, 2020

However, the decade since the original Hypothermia after Cardiac Arrest trial had seen significant advances in pre-hospital, emergency department, and critical care that may have contributed to these outcomes. These results suggest that targeting a lower temperature of 33ºC confers no additional benefit to targeting 36ºC.

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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. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury.

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E-9-1-1 STEMI Coronary ALS 52

EMDocs

DECEMBER 18, 2023

1 The rationale for the shift away from normal saline in 2021 derived from multiple trials, including the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT ED). Procalcitonin and sepsis in the Emergency Department: an update.

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E-9-1-1 ALS Emergency Department Plasma 65

ECG & Echo Learning

JANUARY 18, 2023

IIa C Pre-hospital logistics Management Recommendation Level of evidence The pre-hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch to catheterization laboratory) in order to provide reperfusion therapy as early as possible.

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STEMI Coronary OR Defibrillator 40

EMDocs

JANUARY 4, 2024

Other Norepinephrine or epinephrine are preferred vasopressors when needed. Case Follow-up: The patient required a dose of lorazepam in the emergency department. The patient’s mother believes the patient thought the pills were acetaminophen, and she was taking them for abdominal pain.

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Overdose E-9-1-1 ALS Emergency Department 66

Don't Forget the Bubbles

DECEMBER 5, 2023

Data was collected at 2 emergency departments in America and included assessment by both clinicians and patients for a total of 31 patients. The device was assessed by the clinicians (emergency medicine doctors) using it on ease of use, speed of use and the appearance of the closed wound. Why does it matter?

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Coronary Epinephrine CPR Emergency Department 111

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. He was found by bystanders after he collapsed and 911 was called. EMS physicians report he was found in ventricular fibrillation.

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