REBEL EM

DECEMBER 5, 2023

How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? Bottom Line Up Top: After prompt recognition and appropriate treatment with IM epinephrine, the risk of biphasic reactions are exceedingly low. At the time of discharge, appropriate patient education and prescriptions for IM epinephrine are essential.

Epinephrine 80

Epinephrine Allergic Reaction Emergency Department Emergency Management 80

EMCrit Project

APRIL 26, 2023

Is there an easier way to mix up push-dose epinephrine that is still as safe? EMCrit Project by Scott Weingart, MD FCCM.

Epinephrine 92

Epinephrine 92

REBEL EM

JUNE 14, 2023

to 0.5mg (1mg/mL) IV Bolus: 5 to 20mcg (10mcg/mL) IV Infusion: 1 to 20mcg/min If Poor Response to Conventional Therapy Consider Epinephrine 100mcg IV bolus Norepinephrine infusion 0.1mcg/kg/min Vasopressin 0.01

Allergic Reaction 143

Allergic Reaction Epinephrine OR EMS 143

Pediatric EM Morsels

SEPTEMBER 22, 2023

Both norepinephrine and epinephrine can be used. Epinephrine is key if there is significant bradycardia. Crystalloid may help, but neurogenic shock may not respond to fluid administration. Alpha 1 agonists are necessary to maintain appropriate blood pressure.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

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.

E-9-1-1 246

E-9-1-1 Epinephrine Emergency Department 246

The Skeptics' Guide to EM

JANUARY 13, 2024

We have looked at OHCA more than a dozen times on the SGEM.

CPR 273

CPR Defibrillator First Responder Epinephrine 273

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine. There is drug paraphernalia scattered around the room. Your partner asks if you want to administer naloxone as well.

Naloxone 260

Naloxone NARCAN Overdose CPR 260

ACEP Now

JANUARY 5, 2025

6 Apply direct pressure to the bleeding site with gauze soaked in TXA and epinephrine as a first-line intervention. 7 Epinephrine acts as a local vasoconstrictor, aiding hemostasis, and TXA helps to stabilize clot formation on the exposed tissue and delay hemorrhage progression.

Operating Room 98

Operating Room Epinephrine ALS ED 98

The Skeptics' Guide to EM

DECEMBER 7, 2018

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. An oral airway is placed, peripheral intravenous (IV) line started successfully and the paramedic asks her partner if you want to administer IV epinephrine? He is unsuccessfully shocked.

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

EMS 12-Lead

MARCH 30, 2024

After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). Two paramedics are in the rear of the ambulance managing resuscitation (another crew had arrived and provided support with a driver). During transport, the paramedic not dedicated to compressions is able to establish IV access in the patient's hand.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

University of Maryland Department of Emergency Med

OCTOBER 11, 2023

1,2 Epinephrine autoinjector. Background: It is estimated that nearly 6% of U.S. adults and children report having a food allergy.1,2 Click to view the rest

Epinephrine 63

Epinephrine 63

Emergency Medicine Cases

MAY 24, 2022

In this first part of our 2-part series on Cardiac Arrest Controversies Rob Simard, Bourke Tillman, Sara Gray and Scott Weingart discuss with Anton how best to ensure high quality chest compressions, the pros and cons of mechanical CPR, the literature on dual sequential defibrillation and optimizing pad placement, epinephrine vs vasopressin, amiodarone (..)

Defibrillator 130

Defibrillator Epinephrine CPR EMS 130

Emergency Medicine Cases

JANUARY 14, 2020

The post EM Quick Hits 12 AFib Early vs Delayed Cardioversion, Snake Bites, Ovarian Torsion Myths, Crystal Meth, Aortic Dissection, Severe Asthma Meds appeared first on Emergency Medicine Cases.

Epinephrine 130

Epinephrine EMS Emergency Management Emergency Manager 130

The Skeptics' Guide to EM

DECEMBER 25, 2021

Intraosseous access is quickly obtained, and a dose of epinephrine is provided. Bystander CPR is being performed. The monitor is hooked up. The paramedics performed high-quality CPR and follow their ACLS protocol. CPR is continued while a supraglottic airway is placed successfully.

Epinephrine 130

Epinephrine CPR ALS Emergency Department 130

The Skeptics' Guide to EM

MAY 8, 2021

SGEM#50 looked at a RCT published in JAMA 2013 looking to see if a vasopressin, steroids, and epinephrine (VSE) protocol for IHCAs could improve survival with favorable neurologic outcome compared to epinephrine alone. I have not seen a validation study published.

Epinephrine 130

Epinephrine CPR EMS 130

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.

Epinephrine 98

Epinephrine Emergency Department ALS Operating Room 98

Emergency Medicine Education

SEPTEMBER 2, 2024

Resuscitation recently published an article that assessed the association between intramuscular (IM) epinephrine and survival outcomes, including survival to hospital discharge, survival to hospital admission, and functional survival. Link to article

Epinephrine 40

Epinephrine 40

Core EM

JANUARY 25, 2024

HIET improves contractility without increasing SVR, while vasopressin and epinephrine transiently increase SVR/MAP but worsen cardiac output in anesthetized dogs given propranolol (Holger 2007). Insulin versus vasopressin and epinephrine to treat β-blocker toxicity. Strong trend across different study designs for superiority of HIET.

Overdose 246

Overdose Epinephrine ALS ICU 246

Emergency Medicine Cases

JULY 3, 2018

The post BCE 73 Esmolol in Refractory Ventricular Fibrillation appeared first on Emergency Medicine Cases.

Defibrillator 130

Defibrillator Epinephrine EMS 130

The Skeptics' Guide to EM

OCTOBER 31, 2020

Buffered lidocaine 1%, epinephrine 1:100,000 with sodium bicarbonate (hydrogencarbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. Epinephrine in Local Anesthetics: This will not make the tip of things fall off (nose, fingers, toes, etc). Reference: Vent et al.

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

FOAMfrat

DECEMBER 26, 2024

Children who develop stridor may be treated with racemic epinephrine (0.25- 0.75ml of 2.25% racemic epinephrine to 2.5 Consider nebulized bronchodilators for bronchospasm, using the standard cautions in their use based on the age of the patient.

Epinephrine 116

Epinephrine First Responder OR CAD 116

Emergency Medicine Education

APRIL 11, 2022

Intensive Care Medicine recently published an article with focus on “Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock” This study was in Paris metropolitan region. The choice of vasopressor is always a topic of controversy regarding post cardiac arrest patients.

Epinephrine 40

Epinephrine 40

The Skeptics' Guide to EM

OCTOBER 22, 2022

This includes epinephrine for OHCA, target temperature management, mechanical CPR, supraglottic airways, steroids, hands on defibrillation and many more topics. Background: We have covered Out of Hospital Cardiac Arrests (OHCAs) many, many times on the SGEM.

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

Emergency Medicine Cases

OCTOBER 22, 2019

We discuss that the palpation technique is poor at determining whether or not a patient has a pulse, that the POCUS pulse is more accurate and as rapid compared to the palpation technique at determining whether or not a patient has a pulse, the difference between true PEA arrest, PseudoPEA and PREM, why epinephrine may be harmful in PEA, Weingart's (..)

Epinephrine 130

Epinephrine EMS OR 130

EMDocs

MARCH 9, 2024

1: Epinephrine or Airway First in OHCA? Spoon Feed In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. JAMA Netw Open.

Epinephrine 98

Epinephrine EMS OR 98

Pediatric EM Morsels

JULY 19, 2024

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. . < 25 kg = 250 mg up to 3x > 25 kg = 500 mg up to 3x Direct Pressure Always the best way to stop bleeding. Don’t await for fancy meds to arrive from pharmacy.

E-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

EMergucate

JUNE 27, 2012

Naloxone Epinephrine Atropine Lignocaine yes you can !

Naloxone 100

Naloxone Epinephrine 100

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Epinephrine is provided and you quickly place an advanced airway. A second dose of epinephrine is given, and you start to think about reversible causes and your next steps for in-hospital cardiac arrests (IHCA). Cardiopulmonary resuscitation (CPR) is in progress. The monitor shows a non-shockable rhythm.

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

EMDocs

JANUARY 8, 2024

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. High-dose epinephrine is not recommended for routine use in cardiac arrest. COR 1, LOE B-R. COR 2a, LOE B-R.

Epinephrine 98

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.

Epinephrine 103

Epinephrine Firefighter First Responder Public Safety 103

EMDocs

JANUARY 23, 2024

. #2: Treat bradycardia Calcium: 1 g calcium chloride or 3 g calcium gluconate IV; redosing is often necessary Epinephrine: 5-10 mcg/minute Will improve heart rate and shift potassium intracellularly If still unstable after calcium and epinephrine, pacing will be needed Skip atropine #3: Treat hyperkalemia If thinking BRASH, start hyperkalemia treatment (..)

Epinephrine 111

Epinephrine Overdose OR 111

Core EM

JANUARY 25, 2024

Removal: Lokelma (Sodium Zirconium cyclosilicate) Luckily residents have never had to use Kayexalate Can start working in 1-2 hours of administration 0.37

Epinephrine 246

Epinephrine ED OR 246

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% EMS arrived and found him in Ventricular Fibrillation (VF). He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. sodium bicarbonate.

Defibrillator 125

Defibrillator Coronary Epinephrine ACS 125

The Skeptics' Guide to EM

FEBRUARY 11, 2023

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 ), epinephrine ( SGEM#238 ) and IO vs IV (SGEM#231 and SGEM#340).

Defibrillator 142

Defibrillator Medical Transportation OR CPR 142

Handtevy

DECEMBER 23, 2024

Yet at the same time, despite a large-scale Holmberg study involving over 6,000 patients suggesting potential harm, epinephrine remained part of the pediatric symptomatic bradycardia protocol. That study went to the graveyard and will likely never be repeated.

Advanced Life Support 52

Advanced Life Support Epinephrine Life Support EMS 52

REBEL EM

OCTOBER 11, 2023

” If the patient has compromise to airway, breathing or circulation, they should get immediate epinephrine. In anaphylaxis, think, “If A, B or C, give E.” D-dimer can effectively rule out a larger portion of low risk patients if age adjustment or the YEARS criteria are employed.

Epinephrine 95

Epinephrine EMS OR 95

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. EMS arrives on scene and initiates high quality basic life support (BLS). One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF.

BLS 130

BLS Defibrillator Critical Care CPR 130