The Skeptics' Guide to EM

SEPTEMBER 29, 2018

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

BLS 130

BLS Defibrillator Critical Care CPR 130

EMDocs

APRIL 10, 2024

1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] Supportive care includes: protecting the airway if necessary, supplemental oxygen if needed, and vasopressor support if the patient is hypotensive. 5,8] In one review the incidence of LAST was estimated to be 2.7

E-9-1-1 93

E-9-1-1 Plasma Epinephrine Life Support 93

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. doi: 10.1097/MAT.0000000000001518

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

NAEMSP

JANUARY 5, 2023

Background Despite conflicting literature to support some pharmacological therapies in out of hospital cardiac arrest, the American Heart Association (AHA) currently recommends obtaining vascular access intravenously or intraosseously in cardiac arrest. [1] minutes versus 5.4 minutes). [5] Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468.

E-9-1-1 52

E-9-1-1 Advanced Life Support Epinephrine Life Support 52

Handtevy

APRIL 10, 2019

Data from the AHA and the Pediatric Advanced Life Support (PALS) guidelines consistently report neurologic intact survival from pediatric cardiac arrest to be 3% for infants and 10% for children. By Peter Antevy, MD.

CPR 52

CPR Advanced Life Support EMS Epinephrine 52

AAEM RSA

AUGUST 27, 2020

For both groups, mean time to basic life support was determined to be one-minute, advanced life support started at 10 minutes, and time to ROSC at 25 minutes. Of the 939 patients enrolled, the majority, approximately 80%, in each group had a shockable rhythm on initial assessment and 75% had bystander CPR performed.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

ACEP Now

JULY 7, 2023

2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. 5 More recent literature defines “refractory” as VT or VF that is persistent or recurrent despite three shocks from a defibrillator, three rounds of epinephrine, and use of an antiarrhythmic (i.e.,

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) He was intubated and then went pulseless.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. He is found to be in ventricular fibrillation (VF). Panchal, A.,

E-9-1-1 52

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

REBEL EM

DECEMBER 19, 2022

trying harder and longer knowing they are enrolled in this study) Use of two different models of defibrillators may negatively impact the internal validity of this pilot study Certain baseline characteristics were not balanced, such as: prehospital intubation and Epinephrine administration.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52