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.

Defibrillator 142

Defibrillator Medical Transportation OR CPR 142

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!

E-9-1-1 290

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.

Epinephrine 130

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

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

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 Critical Care 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.

Epinephrine 130

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.

CPR 130

CPR Epinephrine Defibrillator 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.

Epinephrine 98

Epinephrine EMS OR 98

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.

Epinephrine 98

Epinephrine Defibrillator Coronary CPR 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.

Defibrillator 123

Defibrillator Coronary Epinephrine ACS 123

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?

Epinephrine 113

Epinephrine Overdose OR 113

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 OR 246

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

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.

E-9-1-1 271

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

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

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.

Epinephrine 103

Epinephrine EMS OR 103

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?

Epinephrine 103

Epinephrine Firefighter First Responder Public Safety 103

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?

BLS 130

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

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

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.

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 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.

Epinephrine 130

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 Epinephrine 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.

Epinephrine 105

Epinephrine ALS Critical Care Emergency Department 105

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

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

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium. Weakness and Dyspnea with a Sine Wave. It's not what you think! A Very Wide Complex

Defibrillator 100

Defibrillator Epinephrine OR 100

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]

E-9-1-1 111

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

Critical Care Scenarios

NOVEMBER 29, 2020

Be aggressive with fluid resuscitation and consider epinephrine up to 0.06–0.08 Audio quality was a bit dodgy in this one; sorry all!–eds.] Most routine cases will aim to be “bloodless,” i.e. only transfusing autologous (“Cell Saver” blood), as transfusion of banked blood is considered an STS measure.* vancomycin).

ICU 100

ICU Epinephrine OR ED 100

Don't Forget the Bubbles

DECEMBER 25, 2023

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. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% A randomized trial of epinephrine in out-of-hospital cardiac arrest.

Epinephrine 83

Epinephrine ALS OR Paramedic 83

Critical Care Scenarios

DECEMBER 7, 2022

Epinephrine at lower doses is a good second line, providing inotropic support for the RV without much impact on PVR. Takeaway lessons * Evaluate for the risk of decompensation in a patient with known PH and acute illness by considering their most recent echocardiogram, and repeating it as soon as possible after admission.

ICU 100

ICU Critical Care Epinephrine OR 100

The Skeptics' Guide to EM

JUNE 24, 2017

They continue CPR, get intravenous access, give a round of epinephrine and then wonder if they should start rapid cooling en-route to the hospital with some cold saline. By-standard CPR is started and EMS is called. They arrive quickly and take over the resuscitation. She is not in a shockable rhythm.

CPR 100

CPR Epinephrine ALS Paramedic 100

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

CPR 115

CPR STEMI Epinephrine ICU 115

Dr. Smith's ECG Blog

MARCH 1, 2023

In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms. A "STEMI alert" was called and soon cancelled.

Allergic Reaction 52

Allergic Reaction E-9-1-1 Epinephrine Coronary 52

ACEP Now

DECEMBER 6, 2024

Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Overall, cardiac arrest in the setting of coronary vasospasm is thought to be relatively uncommon. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented.

Coronary 98

Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

APRIL 2, 2024

link] __ Case continued There was hypotension, initially controlled with an epinephrine infusion. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Here is the initial ED ECG. What do you think? Rhythm : Residents asked me why it is not VT. So it must be atrial fibrillation.

Defibrillator 131

Defibrillator Coronary Epinephrine CPR 131