The Skeptics' Guide to EM

FEBRUARY 20, 2021

Key results are provided with a number of the study limitations (dog leash) identified.

Epinephrine 130

Epinephrine ALS OR 130

Pediatric EM Morsels

OCTOBER 27, 2023

Most emergency drugs except for amiodarone and succinylcholine are based on ideal body weight [Emergency Medical Services for Children, Luten 2007] Epinephrine, dopamine, fentanyl, ketamine based on what child should weigh. [Krug 2007] What If the Child is Obese or Emaciated? There are other systems that account for body habitus.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

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

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%.

ICU 71

ICU Epinephrine ALS OR 71

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

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. This young male had ventricular fibrillation during a triathlon.

ACS 52

ACS Defibrillator Epinephrine STEMI 52

Handtevy

MARCH 14, 2018

The answer is found in how the brain processes different types of information, a topic beautifully written about by Dr. Daniel Kahneman in his best-selling book, Thinking Fast and Slow. All patients were treated on scene and epinephrine was administered within 5 minutes of arrival on scene. The question is why? What changed?

CPR 52

CPR Epinephrine Critical Care EMS 52

Handtevy

APRIL 10, 2019

Using a different lens to evaluate these links in the chain of survival may provide a different perspective, and inform the way forward. Bystander CPR, 2. Telephone CPR (T-CPR), and 3. On-scene EMS resuscitation. Bystander CPR In the United States today, children in cardiac arrest have less than a 50% likelihood of receiving bystander CPR.

CPR 52

CPR Advanced Life Support EMS Epinephrine 52

REBEL EM

SEPTEMBER 19, 2022

Some look promising (ie eCPR and application of US) while others have been considerably less effective or inconsistent (ie epinephrine and targeted temperature management). This appears to be data dredging or “seeking more information from a data set than it actually contains.”

CPR 52

CPR Defibrillator EMS Epinephrine 52

REBEL EM

DECEMBER 19, 2022

Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF). Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF).

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

FOAMfrat

OCTOBER 1, 2023

This way, I know where the rest of my information needs to go. We want to start an Epinephrine drip. That is the first thing I write down, followed by the setup of the rest of the problem. The reason for this is, it is a great visual to see what unit will go on top and what unit will go on bottom. Step 2: Cancel Units.

Epinephrine 52

Epinephrine OR 52

EMS 12-Lead

MAY 15, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. Epinephrine administered intravenously. They administered 10 mcg of push-dose epinephrine. Atropine and further doses of epinephrine were not administered. Details are edited and redacted to preserve patient anonymity.

Epinephrine 331

Epinephrine Paramedic CPR EMT 331

FOAMfrat

DECEMBER 26, 2024

The ability to mix and match chemicals that are toxic and/or fatal is expansive, and in todays information age, its unfortunately at everyones fingertips. Children who develop stridor may be treated with racemic epinephrine (0.25- 0.75ml of 2.25% racemic epinephrine to 2.5 Chemical Assisted Suicide: Reponder Information.

Epinephrine 116

Epinephrine OR First Responder Emergency Management 116

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. Interested in Other Tricks of the Trade?

E-9-1-1 246

E-9-1-1 Epinephrine Emergency Department 246

EMS 12-Lead

MARCH 30, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. After administering 1mg of epinephrine ROSC is noted with a bradycardic rhythm ( Figure 2 ). Details are edited and redacted to preserve patient anonymity. Junctional Rhythm, occasional PAC's, and artifact.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

ALiEM

NOVEMBER 29, 2023

Xylazine is an alpha-2 agonist similar to clonidine that inhibits the release of norepinephrine and epinephrine resulting in decreased vascular tone and heart rate [4]. Xylazine use is also associated with severe necrotic skin ulcerations and superimposed infection [3, 4]. How does xylazine toxicity present? Published 2022 Apr 20.

Naloxone 169

Naloxone Overdose ALS Epinephrine 169

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU.

Defibrillator 111

Defibrillator CPR Epinephrine Life Support 111

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. They achieved ROSC and wanted to transfer to our institution for post-arrest care. After ROSC achieved: Sinus rhythm.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. Information is scarce when it comes to what constitutes a toxic dose. You can see Left Main and Proximal LAD obstruction, but with some flow, which is saving this patient's life. An Impella device was placed to maintain cardiac output and perfusion pressures.

Defibrillator 130

Defibrillator Coronary ALS STEMI 130

REBEL EM

SEPTEMBER 26, 2022

It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count. There is no information on interventions or medical therapies outside the transfusion strategy. Hayes-Larson 2019).

FFP 52

FFP E-9-1-1 ICU ALS 52

TIMER

SEPTEMBER 28, 2022

This includes providing life-saving epinephrine to a patient having an allergic reaction, splinting a patient’s wounds following a car accident, or even performing CPR on a person experiencing cardiac arrest. Furthermore, you can contact them for all information about their services and programs. appeared first on Timer EMT.

EMT 40

EMT EMT Paramedic Emergency Medical Technician 40

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. You can then add to the learning process by giving them information on definitive care and how what they did fits into the spectrum. Didn’t give it; just took it out of the box.

Paramedic 52

Paramedic OR EMT EMT 52

Dr. Smith's ECG Blog

APRIL 6, 2018

Chest compressions were continued, and the patient was given 1 round of epinephrine, calcium, bicarb, glucose. Fight to get the most accurate information from EMS, family members, police, bystanders, etc. See the following interesting case for another example: Very Wide and Very Fast, What is it? How would you treat?

Defibrillator 52

Defibrillator ICU EMS Plasma 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. When the ECG is nondiagnostic for coronary occlusion, or the patient is suspected of having a non-occlusion MI, consider echocardiography to inform the decision for angiography.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

My Paramedic Blog

FEBRUARY 21, 2015

I was informed this patient was having shortness of breath, felt dizzy and had blurred vision. More epinephrine went in via IV. We arrived on scene , Fire was already there with the patient. Every now and then we checked the ECG monitor and checked for pulse. His eyes were rolled back, glazed, dead. To wake up.

Epinephrine 52

Epinephrine CPR Paramedicine Paramedicine 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I On epinephrine and norepinephrine drips." CT angiogram showed extensive saddle pulmonary embolism.

ACS 52

ACS CPR CAD Heart Attack 52

AAEM RSA

AUGUST 27, 2020

Due to French Law, informed consent was not required as both groups were considered to be receiving components of standard of care, though patients (or their representatives) had the opportunity to decline the usage of their data. Time to TTM was statistically significantly shorter in the IC group (2.2

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Don't Forget the Bubbles

DECEMBER 5, 2023

However the data does not given information on indications for the treatment of reflux, meaning some of the medications could have been prescribed inappropriately. There was no information collected on breast feeding (in terms of protective factor for infection) or social interaction. 1.63) and viral infections (aHR, 1.30; 95% CI, 1.28-1.33).

Coronary 111

Coronary Epinephrine CPR Emergency Department 111

ACEP Now

OCTOBER 28, 2024

Caring for critically ill patients with limited information requires snap assessments and judgements for timely resuscitation and efficient emergency department throughput. He was defibrillated twice and received 2 doses of epinephrine, with return of spontaneous circulation. Sound familiar? This is the essence of emergency medicine.

Emergency Department 52

Emergency Department Defibrillator Epinephrine EMS 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. For more information, see chapter 28 of Smith's " The ECG in Acute MI." A 65 yo woman had felt ill for 36 hours, had seen her MD but without undergoing a cardiac evaluation. She collapsed and 911 was called; she was found pulseless. Plummer D et al.

STEMI 40

STEMI Defibrillator Epinephrine Emergency Department 40

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: 31843324 Bottom line: This information is not new. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. 2024.110266. Epub 2024 Jun 9. J Emerg Med.

Epinephrine 61

Epinephrine Emergency Department Critical Care ICU 61

EMDocs

JANUARY 22, 2025

Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. doi:10.3109/15563659609013811 Micromedex Drug Information, Naloxone. J Med Toxicol. 2016 Mar;12(1):107-10.

Naloxone 98

Naloxone E-9-1-1 Overdose NARCAN 98

Dr. Smith's ECG Blog

APRIL 18, 2025

He suffered another cardiac arrest in the ICU with ROSC after another dose of epinephrine and one round of CPR. Complicating assessment is a lack of information at critical points in the patient's evaluation. The patient was transferred to the ICU on pressors, where a repeat bedside echo showed an LVEF of 10-15%.

ED 80

ED ACS ICU OR 80

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