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

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

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., beta blocker) New medication (e.g., NSAID or potassium sparing diuretic) Ask the following: Is there mild hyperkalemia?

Epinephrine 87

Epinephrine Overdose OR 87

FOAMfrat

DECEMBER 26, 2024

TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES. IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT. REMEMBER, IF YOU ARE TREATING A SUICIDE ATTEMPT SURVIVOR, DO NOT PASS JUDGMENT.

Epinephrine 116

Epinephrine OR First Responder Emergency Management 116

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

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). 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 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

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. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Here is the initial ED ECG. What do you think?

Defibrillator 128

Defibrillator Coronary Epinephrine CPR 128

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 94

E-9-1-1 Plasma Epinephrine Life Support 94

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

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

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% Up to 44% per other sources [12]. And according to a paper from Russotto et al. Of note, in the paper by Russotto et al.,

E-9-1-1 52

E-9-1-1 ALS ACS OR 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. 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

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. Eur J Pediatr. 2024 Apr;183(4):1543-1553.

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. antibiotics, NSAIDs) Acute urticaria with angioedema or anaphylaxis provided that urticaria was still present after initial treatment and alleviation of anaphylaxis symptoms.

Allergic Reaction 52

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

AAEM RSA

AUGUST 27, 2020

The authors also investigated harms in both groups and determined no significant difference in adverse events between both groups. Enrollees were then assigned to either TTM of 33ºC or 36ºC for 36 hours. There was no blinding for the direct care providers, but neurologic prognostication was performed by blinded individuals.

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. Some of you might say, “Hey, that’s great! ” Two points here.

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 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. The cath lab was activated. The interventionalists insisted that the ECGs did not meet STEMI criteria and cancelled the activation, stating that they would consider urgent cath after further stabilization.

E-9-1-1 52

E-9-1-1 STEMI ED EMS 52

REBEL EM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

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. The medic on scene calls on-line medical control to ask for advice, and specifically asks if calcium can be given, as she has “seen it work before” to get pulses back as a “last ditch effort.” mEq/L (OR: 51.11; 95% CI: 3.12−1639.16;

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. I had a reputation as a tough preceptor. I was the one that people either sought out because they wanted the challenge; or the one that they avoided. 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. A Rising Troponin That afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called. 3–8 Shi et al.

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). 2 The astute paramedic recognized this possibility and announced a CODE STEMI.

Coronary 40

Coronary ACS ALS STEMI 40

ECG & Echo Learning

JANUARY 18, 2023

I C Blood samples Management Recommendation Level of evidence Serum biomarkers of myocardial infarction ( troponin ) should be sampled as early as possible without delaying reperfusion therapy. I C Symptom relief Symptom Management Recommendation Level of evidence Hypoxia Oxygen is indicated if SaO2 < 90% or PaO2 < 60 mmHg.

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 74

E-9-1-1 EMS Coronary ACS 74

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). vs. 0.91), positive predictive value (0.27

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

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