The Skeptics' Guide to EM

APRIL 4, 2020

We went four rounds punching and counter punching arguments about critical care controversies. We both agree that the patient deserves the best care, based on the best evidence. It is an example of mixing education and entertainment for some great knowledge translation. The REBEL took the fight to the Skeptic.

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The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

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EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Research interests include simulation-based assessment, transport medicine, and critical care analgesia. He is an assistant professor at the Northern Ontario School of Medicine University and is passionate about health equity for rural and indigenous populations.

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The Skeptics' Guide to EM

FEBRUARY 25, 2023

Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Pediatric Crit Care Med. Apart from high-quality CPR and early defibrillation, many other interventions we try lack a strong evidence base.

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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. Click here to claim your CME credit! Find us on Patreon here! Buy your merch here! . Place an arterial line early. Consider a central one such as in the femoral artery if they’re sick.

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ICU Critical Care Epinephrine OR 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. [Krug 2007] What If the Child is Obese or Emaciated? There are other systems that account for body habitus.

E-9-1-1 274

E-9-1-1 Emergency Medical Services Life Support ALS 274

REBEL EM

APRIL 29, 2024

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. 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.

ALS 104

ALS Epinephrine Critical Care Emergency Department 104

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

Critical Care Scenarios

NOVEMBER 29, 2020

Be aggressive with fluid resuscitation and consider epinephrine up to 0.06–0.08 .* Adding an inotrope can be somewhat diagnostic, as patients with mere myocardial stunning will improve, whereas patients with tamponade will generally have little response.* Give calcium chloride freely to the unstable post-cardiac surgery patient.*

ICU 100

ICU Epinephrine OR ED 100

Handtevy

MARCH 14, 2018

If we remove these decades old requirements we can begin to reshape human behavior at the point of care, where it matters most. In this video we describe a step by step approach to pediatric critical care using training that is specifically geared towards System 2 elimination. What changed?

CPR 52

CPR Epinephrine Critical Care EMS 52

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. 2020), but IV Calcium is still used routinely in some cases in the critical care setting, such as congenital heart disease. Pediatric Critical Care Medicine, 23 (11), 860-871. Kay, J., & Blalock, A.

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

ACEP Now

NOVEMBER 7, 2023

Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. A 67-year-old man presents to the emergency department (ED) in cardiac arrest. He was found by bystanders after he collapsed and 911 was called. EMS physicians report he was found in ventricular fibrillation.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

FOAMfrat

DECEMBER 26, 2024

Children who develop stridor may be treated with racemic epinephrine (0.25- 0.75ml of 2.25% racemic epinephrine to 2.5 Critical Care Clinics, 39(2), 429-441. Consider nebulized bronchodilators for bronchospasm, using the standard cautions in their use based on the age of the patient. 2018, 05 21). 2019, 10 30).

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Epinephrine OR First Responder Emergency Management 116

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.

Overdose 246

Overdose ALS Epinephrine ICU 246

Critical Care Scenarios

MAY 31, 2020

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

Critical Care 100

Critical Care Epinephrine ED ALS 100

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). 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.

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Defibrillator CPR Epinephrine Life Support 106

ECG & Echo Learning

OCTOBER 2, 2022

Epinephrine Shock (any) Cardiac arrest Bronchospasm Anaphylaxis Bradycardia (second-line alternative) Infusion : 0.01 Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 2003; 31:1659. Use of inotropes in the critical care setting.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

EMDocs

JANUARY 4, 2024

Other Norepinephrine or epinephrine are preferred vasopressors when needed. Critical Care Toxicology. Consider lidocaine for associated dysrhythmias. 8 Consider intravenous lipid emulsion (ILE) for cardiotoxicity not responsive to other treatments. 9-12 Do not use this prophylactically in bupropion overdoses. 2014;52(9):969-72.

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Overdose E-9-1-1 ALS Emergency Department 87

Dr. Smith's ECG Blog

APRIL 8, 2016

Crit Care Med. 1991 May;19(5):694-9 Objective: To evaluate the efficacy and safety of potassium replacement infusions in critically ill patients. Setting: Multidisciplinary critical care unit. Design: Prospective cohort study. mmol/L (n = 26), 3.0 The incidence of hypokalemia (potassium less than 3.5

STEMI 52

STEMI Plasma Defibrillator OR 52

AAEM RSA

AUGUST 27, 2020

However, the decade since the original Hypothermia after Cardiac Arrest trial had seen significant advances in pre-hospital, emergency department, and critical care that may have contributed to these outcomes. These results suggest that targeting a lower temperature of 33ºC confers no additional benefit to targeting 36ºC.

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E-9-1-1 CPR ICU ALS 52

The Skeptics' Guide to EM

NOVEMBER 30, 2024

Guest Skeptic: Missy Carter is a PA currently practicing in critical care after having attended the University of Washington's MEDEX program. The paramedic is trying to get intravenous (IV) access to give epinephrine per the protocol. Epinephrine has long been a cornerstone in the management of OHCA.

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Epinephrine OR CPR Paramedic 248

Critical Care Scenarios

JANUARY 8, 2025

If you’re above this DBP, just skip epinephrine, which will probably merely be toxic (ie promoting arrhythmias). * Finally, if it’s truly just vasoplegia, consider other moves, such as adding vasopressin/steroids (an evidence-based practice) or high-dose epinephrine (5 mg epinephrine).

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Epinephrine Defibrillator Coronary ED 214

EMDocs

MAY 6, 2025

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. m/s)problematic and elevated > 50 mm Hg (4.5 J Thorac Dis. 2015;7(9):E365-E369. J Clin Med.

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E-9-1-1 Epinephrine ICU ALS 86

EMDocs

OCTOBER 29, 2024

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. m/s)—problematic and elevated > 50 mm Hg (2.5 J Thorac Dis. 2015;7(9):E365-E369. J Clin Med.

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E-9-1-1 ICU Epinephrine EMS 98

FOAMfrat

DECEMBER 4, 2024

Fast forward a few years, maybe a critical care class or a few Studio modules, and now we’ve learned that there’s a whole world of vasopressors, inotropes, inopressors, and inodilators out there. Low-dose epinephrine is a strong beta-1 drug with minimal alpha-1 effects if you stay below ~0.08 mcg/kg/min. link] Levy, B.,

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Coronary STEMI Epinephrine Critical Care 64

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: 38857847 Bottom line: This before and after study demonstrates an association between early IM epinephrine and survival from cardiac arrest. Resuscitation. 2024 Aug;201:110266.

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Epinephrine Emergency Department Critical Care ICU 60

EMOttawa

JANUARY 6, 2025

Methodology: 4/5 Usefulness: 3/5 Couper K, et al. N Engl J Med. 2024 Oct 31:10.1056/NEJMoa2407780. Question and Methods:This multi-center, open label randomized control trial aimed to assess 30-day survival in patients with out of hospital cardiac arrest (OOHCA) who received IO versus IV access first.

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ALS Critical Care Epinephrine 82

FOAMfrat

NOVEMBER 25, 2024

In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. Sure, we still do CPR, defibrillate as needed, and give Epinephrine based upon our local guidance. Critical Care Medicine, 33 (10), S279-S285. Could this work for the AFE patient?

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Epinephrine CPR Operating Room Plasma 105

EMDocs

MARCH 18, 2025

Consultation needed for definitive management: Pulmonology/critical care, IR, and cardiothoracic surgery; admission to the critical care setting (likely requires transfer). Bronchoscopy can be used for bleeding control with cold saline, epinephrine, activated factor VIIa, or TXA.

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E-9-1-1 FFP Critical Care ALS 80