The Skeptics' Guide to EM

NOVEMBER 13, 2021

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 at Nassau University Medical Center. Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED).

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

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.

E-9-1-1 271

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

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.

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

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.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

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.

Epinephrine 130

Epinephrine ALS Emergency Department EMS 130

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.

CPR 130

CPR ICU Critical Care Defibrillator 130

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 ).

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

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.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

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.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

ACEP Now

DECEMBER 6, 2024

Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm.

Coronary 98

Coronary Life Support ALS Emergency Department 98

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.

ACS 52

ACS Defibrillator Epinephrine STEMI 52

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.

E-9-1-1 69

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

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.

EMT 52

EMT EMT Emergency Medical Technician Ambulance Driver 52

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).

Allergic Reaction 52

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

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

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.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 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.

Epinephrine 52

Epinephrine ED Emergency Department ALS 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.,

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 52

REBEL EM

DECEMBER 19, 2022

trying harder and longer knowing they are enrolled in this study) Use of two different models of defibrillators may negatively impact the internal validity of this pilot study Certain baseline characteristics were not balanced, such as: prehospital intubation and Epinephrine administration.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

ALiEM

MAY 29, 2023

Initial Management After a rapid assessment, we inserted an anterior nasal pack, soaked in epinephrine, TXA, and an antibiotic-based lubricant. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion. Reference Goralnick E.

E-9-1-1 246

E-9-1-1 Epinephrine Emergency Department 246

FOAMfrat

DECEMBER 26, 2024

IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT. Children who develop stridor may be treated with racemic epinephrine (0.25- 0.75ml of 2.25% racemic epinephrine to 2.5 TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT.

Epinephrine 116

Epinephrine OR First Responder Emergency Management 116

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.

CPR 130

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

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

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?

Epinephrine 130

Epinephrine Emergency Department EMS ALS 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.

Coronary 128

Coronary ACS Emergency Department Defibrillator 128

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.

Emergency Medical Services 98

Emergency Medical Services Emergency Department OR ED 98

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.

E-9-1-1 92

E-9-1-1 ALS Emergency Department Plasma 92

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

Epinephrine 98

Epinephrine Emergency Department EMS OR 98

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.

Epinephrine 100

Epinephrine ALS Emergency Department EMS 100

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.

Defibrillator 110

Defibrillator CPR Epinephrine Life Support 110

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.

Overdose 93

Overdose E-9-1-1 ALS Emergency Department 93

Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. We analyse disease-specific and emergency care data in order to improve the recognition of subarachnoid haemorrhage as a cause of cardiac arrest. Results: Over 8.5

STEMI 52

STEMI Coronary ACS Emergency Department 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.

E-9-1-1 52

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

STEMI 52

STEMI ACS Coronary Defibrillator 52

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.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 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.

E-9-1-1 52

E-9-1-1 ALS ACS OR 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.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52