EMDocs

JANUARY 23, 2024

An inciting event will typically push them over the edge into BRASH syndrome: Dehydration Hypotension from sepsis or another condition GI illness Dosage increase of a chronic medication (e.g., The key is a patient who is on an AV nodal blocker and who has some sort of risk factor for renal insufficiency. beta blocker) New medication (e.g.,

Epinephrine 113

Epinephrine Overdose OR 113

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. Watch the video to hear directly from attendees.

Epinephrine 103

Epinephrine Firefighter First Responder Public Safety 103

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Audrey’s academic interests include trauma and resuscitation. Outside of medicine, Audrey likes to play rugby and run.

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

REBEL EM

SEPTEMBER 13, 2023

Stable patients with isolated anterior tongue edema should undergo fiberoptic laryngoscopy in the ED ( McCormick 2011 ) Avoid unnecessary airway manipulation (can exacerbate edema) Edema may obscure the neck anatomy Airway Management Early intubation often indicated as swelling may progress and supraglottic rescue devices may be ineffective Consider (..)

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

EMDocs

APRIL 10, 2024

While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration. 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3]

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

REBEL EM

MAY 29, 2023

The study was too small to make strong conclusions about adverse events. 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 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

ICU 145

ICU ALS Epinephrine OR 145

Don't Forget the Bubbles

DECEMBER 25, 2023

However, it was still patient-oriented, considering the patient’s clinical response, symptom resolution, and adverse events. 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. vs. 2.4% ). BMJ Evid-Based Med. N Engl J Med.

Epinephrine 83

Epinephrine ALS OR Paramedic 83

Dr. Smith's ECG Blog

APRIL 2, 2024

link] __ Case continued There was hypotension, initially controlled with an epinephrine infusion. For this reason we did not believe this was an acute coronary event and did not activate the cath lab. It is not yet available, but this is your way to get on the list. Cardiology agreed. Old records still had not appeared.

Defibrillator 133

Defibrillator Coronary Epinephrine CPR 133

ACEP Now

DECEMBER 6, 2024

Attention was turned to the consideration of severe coronary vasospasm as the inciting event for cardiopulmonary arrest and the nidus for refractory ventricular fibrillation. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. (Click to enlarge.)

Coronary 98

Coronary Life Support ALS Emergency Department 98

The Overrun Podcast

MARCH 28, 2021

But we need to prepare for these low-frequency, high-stress events to give out patients every possible chance to survive. On another note, go to [link] to see the talk that inspired this episode. This is some of the best paramedic level training out there today, and it’s NREMT approved, and FREE!

Epinephrine 52

Epinephrine Paramedic ED EMS 52

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

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. Adverse Effects: No serious adverse events were noted. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds.

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

Dr. Smith's ECG Blog

JULY 24, 2018

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. Dr. Meyers skillfully walks us through the events in this case, with important lessons to be learned.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

FOAMfrat

OCTOBER 20, 2023

titled “Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients from 29 Countries,” at least one major critical event occurred after intubation in 45.2% The higher the shock index, the more likely adverse events are to occur; such as hypotension or cardiac arrest. Up to 44% per other sources [12].

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Don't Forget the Bubbles

MAY 8, 2024

2024 Apr 3:114037 Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Infants Born Extremely Preterm. Use of Initial Endotracheal versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database. Marinelli T, et al. Kausch SL, et al.

E-9-1-1 69

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

REBEL EM

JANUARY 23, 2023

T5 (3.9%) patients with adverse events were reported in the IV Cetirizine group compared to 18 (3.9%) in the IV diphenhydramine group. A contraindication, known allergy, or suspected intolerability to the study medication. The effectiveness of IV cetirizine was determined to be statistically non-inferior. in the IV cetirizine group and 2.1

Allergic Reaction 52

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

Dr. Smith's ECG Blog

JANUARY 19, 2020

At about 30 minutes after presentation, the patient had acceptable vital signs with the TVP and low dose epinephrine drip. Bedside echo showed obvious inferior wall motion abnormality and good TVP placement, no effusion. Another ECG was obtained during pacing: Mostly paced rhythm with PVCs (#3, #6, #9, #12). mm STE with 9.5

E-9-1-1 52

E-9-1-1 STEMI ED EMS 52

AAEM RSA

AUGUST 27, 2020

The authors also investigated harms in both groups and determined no significant difference in adverse events between both groups. Secondary outcomes included mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS), infections, and hematologic adverse events.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

ECG Medical Training

DECEMBER 4, 2016

Let me preface this by saying that these are my opinions which are based on my review of the medical literature and my real life experiences using mechanical CPR at the system level, including post-event analysis of resuscitations in which mechanical CPR was used. Start an IV and give epinephrine?

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 52

REBEL EM

SEPTEMBER 26, 2022

It’s unclear whether interventions such as cauterization, clip placement, epinephrine injection, etc., Significant coagulopathy: INR > 1.8 The care team could have provided more aggressive medical management outside the transfusion strategy to one arm over another, leading to co-intervention bias. were performed.

FFP 52

FFP E-9-1-1 ICU ALS 52

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Calcium Chloride Is Given to Sicker Patients During Cardiopulmonary Resuscitation Events. CPR is taken over by responding crews, and he is placed on a cardiac monitor/defibrillator. Sanchez, G., Venkataraman, P., Savorgnan, F.

E-9-1-1 52

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

The Overrun

APRIL 19, 2021

The call involved a sick patient where the student, who was on the verge of going to boards, pulled out the wrong concentration of epinephrine. A debrief for a student is a critical event. I remember one story a preceptor had told me when I was a student. Didn’t give it; just took it out of the box.

Paramedic 52

Paramedic EMT EMT OR 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. This list takes on new relevance given the ongoing Covid-19 pandemic — which predisposes to acute thrombotic events, stress cardiomyopathy ( Takotsubo ), infarction/ischemia and myocarditis.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: In a large randomized trial of dopamine vs. norepinephrine (11) for shock which was published after the above-mentioned recommendations, dopamine had more adverse events (especially severe dysrhythmias, and especially atrial fibrillation). The mean MAP for these patients was 81 +/- 13.

Coronary 40

Coronary ACS ALS STEMI 40

ECG & Echo Learning

JANUARY 18, 2023

IIa B In STEMI patients with stent implantation and an indication for oral anticoagulation, triple therapyd should be considered for 1–6 months (according to a balance between the estimated risk of recurrent coronary events and bleeding).

STEMI 40

STEMI Coronary OR Defibrillator 40

EMDocs

JANUARY 20, 2024

Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

E-9-1-1 101

E-9-1-1 EMS Coronary ACS 101

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). 32,33 Once the dose of norepinephrine is between 0.25-0.5 units/minute.

E-9-1-1 91

E-9-1-1 ALS Emergency Department Plasma 91

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. Here is the written paramedic report available after all the events were over: Patient was seen by witnesses to become unresponsive. including epinephrine, and there was ROSC. Mistaking such cases as an acute cardiac event is not uncommon because of these ECG changes.

STEMI 89

STEMI Paramedic E-9-1-1 Epinephrine 89

EMDocs

MARCH 18, 2025

Studies from the 1980s and 1990s found 5-14% of patients with hemoptysis had a life-threatening event (7,8). Bronchoscopy can be used for bleeding control with cold saline, epinephrine, activated factor VIIa, or TXA. Epidemiology: Prevalence of hemoptysis ranges between 0.2-14%. Wide range in numbers for MH.

E-9-1-1 81

E-9-1-1 FFP Critical Care ALS 81

ACEP Now

OCTOBER 29, 2024

He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. Genetic testing may inform prognosis and management, as certain SCN5A mutations are associated with a higher risk of arrhythmic events; although, the yield of genetic testing is fairly low in this condition. Click to enlarge.)

E-9-1-1 52

E-9-1-1 Defibrillator ALS Epinephrine 52