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Updates in High dose Insulin and Euglycemia Therapy (HIET) for the treatment of Beta-adrenergic Receptor and Calcium Channel Antagonists Overdose

Core EM

Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Beta-adrenergic receptor antagonists (Beta blockers, BB) and calcium channel antagonists (calcium channel blockers) are common drugs that can produce profound cardiac depression and shock when taken in overdose.

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SGEM#453: I Can’t Go For That – No, No Narcan for Out-of-Hospital Cardiac Arrests

The Skeptics' Guide to EM

You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine. Naloxone is a well-established medication used primarily for reversing opioid overdoses. There is drug paraphernalia scattered around the room. Today’s study looks at the role of naloxone in OHCA.

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ACMT Toxicology Visual Pearl: Needle to Necrosis

ALiEM

Recently, xylazine has gained attention in the media with increasing reports of xylazine-related overdose deaths in patients. When combined with illicit opioids such as heroin and fentanyl, xylazine may increase the risk of fatal overdose given the augmented sedation and respiratory depression effects [2]. Published May 2023.

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Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Dr. Smith's ECG Blog

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.

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emDOCs Podcast – Episode 93: BRASH Syndrome

EMDocs

. #2: Treat bradycardia Calcium: 1 g calcium chloride or 3 g calcium gluconate IV; redosing is often necessary Epinephrine: 5-10 mcg/minute Will improve heart rate and shift potassium intracellularly If still unstable after calcium and epinephrine, pacing will be needed Skip atropine #3: Treat hyperkalemia If thinking BRASH, start hyperkalemia treatment (..)

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2023 AHA Update on ACLS

EMDocs

Calcium is associated with harm but is still necessary in certain situations (hyperkalemia, calcium channel blocker overdose) (Level 3 recommendation: no benefit). Vasopressor medications during cardiac arrest We recommend that epinephrine be administered for patients in cardiac arrest. COR 1, LOE B-R. COR 2a, LOE B-R. COR 2b, LOE B-R.

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Ep 155 Treatment of Bradycardia and Bradydysrhythmias

Emergency Medicine Cases

AV nodal blocker overdose? What are the latest recommendations about dosing of atropine and when is atropine likely to be detrimental? How is the treatment of bradycardia different in the patient with hypothermia? Cardiac ischemia? Myxedema coma? What are the most common pitfalls in utilizing transcutaneous and transvenous pacing?

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