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We’ll keep it short, while you keep that EM brain sharp. 2][3] Bacterial tracheitis should be suspected over croup if nebulized racemic epinephrine or steroids do not improve the clinical course. [2][3][8] link] The post EM@3AM: Bacterial Tracheitis appeared first on emDOCs.net - Emergency Medicine Education. 1983;137(8):764.
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.
What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 It also reduced length of stay in ICU and hospital without adverse effects. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%
Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] If epinephrine is used, small initial doses ( <1 ug/kg) are preferred.
Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.
to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5) Until further evidence presents itself, what this study offers is building upon what we do know.
The TEG group had a shorter ICU length of stay in the first admission. Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease. were performed.
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. He had been given 3 grams Ca gluconate by EMS. After ROSC achieved: Sinus rhythm. QRS much more narrow.
Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column. If it is determined that the bleeding originates from one lung it is recommended to position the patient in lateral decubitus with the bleeding lung down to avoid contamination of the contralateral lung. A special thanks to Drs.
Today, she would not get out of bed, prompting the facility to call EMS. 34 If a MAP of 65 mmHg is still not achieved, epinephrine should be added as a third agent (Figure 1). Evidence continues to support norepinephrine, vasopressin, and epinephrine as the order of vasopressor initiation, respectively, titrated to MAP of 65 mmHg.
EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose. Learning Points: 1.
Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA), Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!
In the EMS setting, the most common cardiogenic shock patient is most likely a STEMI. LVEDP (measured in the ICU using a Swan-Ganz or pulmonary artery catheter) is the pressure inside the left ventricle at the end of diastole, when the LV is at its fullest. Aortic diastolic blood pressure is easy enough. LVEDP is a little more complex.
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