The Skeptics' Guide to EM

JANUARY 13, 2024

For a full list of check out the links below to the SGEM blogs: * SGEM#50: Under Pressure Journal Club: Vasopressin, Steroids and Epinephrine in Cardiac Arrest * SGEM#54: Baby It’s Cold Outside: Pre-hospital Therapeutic Hypothermia in Out of Hospital Cardiac Arrest * SGEM#59: Can I Get a Witness: Family Members Present During CPR * SGEM#64: Classic (..)

CPR 273

CPR Defibrillator First Responder Epinephrine 273

REBEL EM

DECEMBER 5, 2023

How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? Bottom Line Up Top: After prompt recognition and appropriate treatment with IM epinephrine, the risk of biphasic reactions are exceedingly low. At the time of discharge, appropriate patient education and prescriptions for IM epinephrine are essential.

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Epinephrine Allergic Reaction Emergency Department Emergency Manager 80

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.

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Epinephrine First Responder OR CAD 116

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). first appeared on The Skeptics Guide to Emergency Medicine.

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Defibrillator Medical Transportation OR CPR 142

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

Pediatric EM Morsels

JULY 19, 2024

Soak the gauze with epinephrine (1:10,000) or TXA (our THIRD route of administration) Apply pressure laterally to the tonsillar fossa with the gauze covered Magill forceps. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get IV access!

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E-9-1-1 Epinephrine Emergency Department OR 290

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

DECEMBER 25, 2021

Intraosseous access is quickly obtained, and a dose of epinephrine is provided. Disclaimer: “While I am proud to be attending this institution, my opinions expressed here are mine alone and do not represent my residency program, hospitals I work at, or any other affiliated organizations.” ” Reference: Vallentin et al.

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Epinephrine CPR ALS Emergency Department 130

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.

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Overdose Epinephrine ALS ICU 246

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.,

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Defibrillator OR ALS Epinephrine 98

Core EM

JANUARY 25, 2024

mEq/L Effect starts 10-20 mins after administration and can last 4-6 hours Albuterol 10-20 mg over 10 mins (NB: higher dose than for asthma) Peak effect at 90 mins Decreases by 0.5 – 1.0 mEq/L alone With insulin, ~1.2 mEq/L, additive effect Bicarbonate Controversy. mEq/L alone With insulin, ~1.2

Epinephrine 246

Epinephrine ED OR 246

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 Operating Room 98

Emergency Medicine Cases

OCTOBER 22, 2019

The post Ep 131 PEA Arrest, PseudoPEA and PREM – With Simard and Weingart appeared first on Emergency Medicine Cases.

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Epinephrine EMS OR 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

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 98

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. Then assume there is ACS.

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Defibrillator Coronary Epinephrine ACS 126

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 98

Core EM

JANUARY 25, 2024

Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. 1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED.

Epinephrine 246

Epinephrine ED Emergency Department Ambulance 246

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? Is there some renal injury?

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Epinephrine Overdose OR 108

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. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Validation study done in Italy.

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

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.

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

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

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Allergic Reaction Plasma ED Epinephrine 188

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. Missed Wave 2024 or want to revisit the highlights?

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Epinephrine Firefighter First Responder Public Safety 103

The Skeptics' Guide to EM

MARCH 2, 2019

There is no evidence for a patient-oriented benefit with epinephrine ( SGEM#238 ), other ACLS drugs ( SGEM#64 ), pre-hospital therapeutic hypothermia ( SGEM#54 , SGEM#183 ), or mechanical CPR ( SGEM#136 ). Key to survival is high-quality CPR and early defibrillation. One issue we have not discussed is endotracheal intubation.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. They wonder whether it would be better to attempt a peripheral intravenous (IV) line or intraosseous access first?

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BLS Defibrillator Critical Care CPR 130

The Skeptics' Guide to EM

FEBRUARY 20, 2021

Myth #1: The use of non-selective NSAIDs will cause a nonunion in long bone fractures When bones break, they usually heal with either surgical or non-surgical management. Sometimes the healing process can take longer than usual (delayed union), does not heal (non-union) or in poor alignment (malunion). J Bone Joint Surg Am.

Epinephrine 130

Epinephrine ALS OR 130

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 95

The Skeptics' Guide to EM

JANUARY 9, 2021

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 ), and epinephrine ( SGEM#238 ). One aspect we have not looked at is the “load and go” vs. “stay and play” approach for OHCA.

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

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?

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Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

There have been a number of papers published since OPALS that support the findings of not using ACLS drugs like epinephrine for OHCA: * Olavseengen et al. He is also the CME editor for Academic Emergency Medicine and the associate editor for emergency medicine simulation at the AAEM MedEdPORTAL. vs. 66.8%, p=0.73). JAMA 2009 * Jacobs et al.

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Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. This was the third time coming to McGill University Department of Emergency Medicine to give Grand Rounds. The bottom line was this was interesting, but VSE protocol was not ready for routine use.

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Epinephrine Emergency Department EMS ALS 130

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will not work. Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. Reference: Sinert et al.

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Epinephrine ALS Emergency Department EMS 130

The Skeptics' Guide to EM

FEBRUARY 25, 2023

1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353. . * Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU). But it’s not that straightforward.

CPR 130

CPR ICU Critical Care Defibrillator 130

REBEL EM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line.

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Epinephrine ALS Critical Care Emergency Department 105

The Skeptics' Guide to EM

APRIL 4, 2020

Four Critical Care Controversies: * Round#1: Mechanical CPR – SGEM#136 * Round#2: Epinephrine in Out-of-Hospital Cardiac Arrest (OHCA) – SGEM#238 * Round#3: Stroke Ambulances with CT Scanners * Round#4: Bougie for First Pass Intubation – SGEM#271 Conclusion/Winner – Use EBM and the winner is the patient We appreciate Dr.

Critical Care 130

Critical Care Epinephrine CPR Ambulance 130

EMDocs

APRIL 10, 2024

1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] If epinephrine is used, small initial doses ( <1 ug/kg) are preferred. mL/kg/min. [2]

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E-9-1-1 Plasma Epinephrine Life Support 110

Critical Care Scenarios

MAY 31, 2020

To hemodynamically manage RV failure without worsening RV afterload, consider the Rule of 8s cocktail:* Epinephrine.08 The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. an overly high FiO2 will tend to worsen V/Q matching.*

Critical Care 100

Critical Care Epinephrine ED ALS 100