Core EM

JANUARY 25, 2024

Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergency department, such as septic shock, undifferentiated shock and hypovolemic shock.

Epinephrine 246

Epinephrine Critical Care Emergency Department ED 246

EMS 12-Lead

MAY 15, 2024

Epinephrine administered intravenously. They administered 10 mcg of push-dose epinephrine. Atropine and further doses of epinephrine were not administered. Paramedics continued compressions and ventilations (30:2 per protocol prior to advanced airway placement) and had an initial rhythm of asystole. Approach TCP with skepticism.

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Epinephrine Paramedic CPR ED 331

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.

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Epinephrine 40

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.

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Epinephrine 87

Emergency Medicine Cases

APRIL 2, 2024

What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic? We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma?

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Epinephrine EMS 344

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

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Allergic Reaction Epinephrine OR EMS 145

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.

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Epinephrine Emergency Department ALS Critical Care 98

University of Maryland Department of Emergency Med

JANUARY 30, 2023

When managing a hypotensive patient who may have some element of cardiogenic shock, it has long been debated whether it is better to start an. Click to view the rest

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Epinephrine 40

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 (..)

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Defibrillator Epinephrine CPR EMS 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.

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Epinephrine EMS OR 82

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.

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Naloxone NARCAN Overdose CPR 242

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.

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Epinephrine CPR ALS Emergency Department 130

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.

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Epinephrine Defibrillator Coronary CPR 82

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.

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Epinephrine CPR EMS 130

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.

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E-9-1-1 Epinephrine Emergency Department 246

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.

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Epinephrine Life Support Advanced Life Support Defibrillator 130

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.

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CPR Defibrillator Epinephrine Firefighter 130

Broome Docs

NOVEMBER 17, 2024

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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Epinephrine Emergency Department Critical Care ICU 62

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.

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E-9-1-1 Epinephrine ALS EMS 300

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.

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Epinephrine EMS Emergency Management Emergency Manager 130

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.

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Epinephrine Critical Care Emergency Department Life Support 100

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.

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Epinephrine Emergency Department EMS ALS 130

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 (..)

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Epinephrine Overdose OR 87

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.

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Epinephrine EMS OR 116

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.

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Defibrillator Coronary ACS Epinephrine 110

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 ALS Epinephrine Critical Care 246

Prehospital Emergency Care Podcast

AUGUST 28, 2024

We talk about engaging manuscripts in this journal like: COVID-19 Testing Among Out-of-Hospital Cardiac Arrest Patients: Implications for Public Health & Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest Click here to download it today! As always THANK YOU for listening.

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Epinephrine 52

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.

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CPR Paramedic Ambulance Defibrillator 312

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 (..)

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Epinephrine EMS OR 130

The Skeptics' Guide to EM

JANUARY 13, 2024

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

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CPR Defibrillator First Responder Epinephrine 223

Dr. Smith's ECG Blog

MARCH 1, 2023

In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms.

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Allergic Reaction E-9-1-1 Epinephrine Coronary 52

Emergency Medicine Cases

JULY 3, 2018

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

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Defibrillator Epinephrine EMS 130

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).

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Defibrillator Medical Transportation OR CPR 139

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium.

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Defibrillator Epinephrine OR 130

Don't Forget the Bubbles

DECEMBER 25, 2023

Disease-Oriented Outcomes (DOOs) The PARAMEDIC-2 trial looked at the effectiveness of epinephrine in adult patients who suffered an out-of-hospital cardiac arrest. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% A randomized trial of epinephrine in out-of-hospital cardiac arrest.

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Epinephrine ALS OR Paramedic 83

EMDocs

OCTOBER 29, 2024

EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. m/s)—problematic and elevated > 50 mm Hg (2.5 Left ventricular outflow tract gradient variability in hypertrophic cardiomyopathy. Clin Cardiol. 2009;32(7):397-402. doi:10.1002/CLC.20594 20594 MOZELL D, SHAH N, CASTILLON JJR, GONUGUNTLA VT, AWERBUCH E.

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E-9-1-1 ICU Epinephrine EMS 87

FOAMfrat

AUGUST 1, 2023

In this book, we're coving: Oxygen Albuterol and Atrovent Epinephrine Aspirin Nitroglycerin Naloxone Oral Glucose Gel and Glucagon + Flashcards in the back! We've also included medication profiles, tips and tricks from experienced providers, and flashcards for each medication to help you hone your med knowledge base!

EMT 52

EMT EMT Naloxone Epinephrine 52