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% Confirmation of sinus tachycardia should be easy to verify when the heart rate slows a little bit ( as the patient's condition improves ) — allowing clearer definition between the T and P waves.

Defibrillator 125

Defibrillator Coronary Epinephrine ACS 125

Handtevy

DECEMBER 23, 2024

Yet at the same time, despite a large-scale Holmberg study involving over 6,000 patients suggesting potential harm, epinephrine remained part of the pediatric symptomatic bradycardia protocol. That study went to the graveyard and will likely never be repeated. For this update, ILCOR examined 31 studies spanning six areas of interest.

Advanced Life Support 52

Advanced Life Support Epinephrine Life Support EMS 52

The Skeptics' Guide to EM

APRIL 4, 2020

This is being posted now because a high-definition video is available on YOUTUBE for those who could not attend or for those who want to watch this epic match again. How the world has changed with COVID19. You can see the original SGEM Xtra post from March 2019. It has more details about each issue we discussed and our slides.

Critical Care 130

Critical Care Epinephrine CPR Ambulance 130

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%

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

EMDocs

APRIL 2, 2024

The Code Whatever caused the initial arrest Iatrogenic injuries from CPR Patients are in a pathophysiologic state that is being called “post-cardiac arrest syndrome” Hypoxic brain injury Myocardial dysfunction Systemic ischemia/reperfusion injury SIRS Response Very fragile state Hard to diagnose what is going on Small Things Matter Overview – (..)

CPR 114

CPR STEMI Epinephrine ICU 114

REBEL EM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. IO Location, Contraindications & Infusion Rates IO access can be obtained in numerous locations with the most common sites being the proximal humerus and proximal tibia.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

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

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. Application to Today's Case: As per Dr. Meyers — No definitive explanation for the marked ST segment deviation seen in ECG #1 was determined.

Allergic Reaction 52

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

REBEL EM

NOVEMBER 6, 2023

to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5) REFERENCES: Hiruy A, et al.

ICU 71

ICU Epinephrine ALS OR 71

Core EM

OCTOBER 2, 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%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Dr. Smith's ECG Blog

OCTOBER 28, 2013

Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. The patient was taken for an angiogram and had an 80% LAD lesion, but it could not be definitely determined whether this was an acute thrombotic lesion or a chronic stable lesion. It was stented.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

APRIL 29, 2020

She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. The ultimate reason for the long QT was never definitively determined.

Defibrillator 52

Defibrillator Epinephrine Coronary OR 52

Broome Docs

APRIL 6, 2023

As always the links to the papers are in the write up below and you definitely should read them rather than believe a couple of nerds amusing themselves upon the internet. Epinephrine metered-dose inhaler for pediatric croup. Beware the possibility of P-hacking here, don’t rush out and buy shares in Zinc mining futures!

Epinephrine 52

Epinephrine ED Emergency Department ALS 52

FOAMfrat

OCTOBER 1, 2023

We want to start an Epinephrine drip. Medical Definition of GTT.” We want to administer TXA 1g diluted in 100mLs over 10 mins. Our drop factor tubing is 10gtts/mL. What will our rate in gtts/min be? My hypotensive septic patient needs an additional pressor. Our concentration is 1mg/100mLs. We want to initiate the drip at 2mcg/min.

Epinephrine 52

Epinephrine OR 52

REBEL EM

JANUARY 23, 2023

Definition, Classification, and Routine Diagnosis of Urticaria: A Consensus report11this Consensus Report Is the Result of a Panel Discussion during the International Clinically Oriented ESDR Symposium ‘Urticaria 2000’.” A contraindication, known allergy, or suspected intolerability to the study medication. Arch Dermatol. 1977;113:80-90.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 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

Dr. Smith's ECG Blog

JANUARY 19, 2020

At about 30 minutes after presentation, the patient had acceptable vital signs with the TVP and low dose epinephrine drip. R ight- s ided c hest l eads would have provided a more definite answer regarding associated acute RV involvement. Bedside echo showed obvious inferior wall motion abnormality and good TVP placement, no effusion.

E-9-1-1 52

E-9-1-1 STEMI ED EMS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

6,7 Surgical repair of AS, by either TAVR or SAVR, is the definitive treatment for this condition. Once a patient is stabilized, determining the extent of damage to their myocardium and a plan for definitive management can then be determined. It has been recommended as a bridge to surgery in those that are not candidates for surgery.

Coronary 40

Coronary ACS ALS STEMI 40

EMDocs

OCTOBER 19, 2024

2][3] Definitive diagnosis is made by laryngoscopy or bronchoscopy showing normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates. [3] 2][3] Bacterial tracheitis should be suspected over croup if nebulized racemic epinephrine or steroids do not improve the clinical course. [2][3][8]

EMS 109

EMS E-9-1-1 Epinephrine OR 109

The Skeptics' Guide to EM

MARCH 2, 2019

They had a difficult time getting a definitive airway pre-hospital. 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 ). Background: We have covered OHCA many times on the SGEM.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

The Skeptics' Guide to EM

MARCH 5, 2022

The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. Background: There are many things in medicine that could be considered myth or dogma. We have covered some of these over the 10 years. JAMA Feb 2009 looked at the ACC/AHA guidelines from 1984 to 2008.

Epinephrine 100

Epinephrine ALS OR 100

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. There is no definite evidence of acute ischemia. (ie, This is an important finding related to the etiology and treatment of these malignant arrhythmias — since by definition, PMVT with a prolonged QTc is classified as Torsades de Pointes ( and entails different treatment recommendations ).

Defibrillator 132

Defibrillator Coronary ALS STEMI 132

ACEP Now

NOVEMBER 14, 2023

The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient. 2 Death from hemoptysis is akin to drowning, so airway considerations usually take precedence over hemodynamic considerations.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. Of course this must be followed immediately with definitive therapies and potassium source control if possible.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

REBEL EM

SEPTEMBER 26, 2022

Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease. It’s unclear whether interventions such as cauterization, clip placement, epinephrine injection, etc.,

FFP 52

FFP E-9-1-1 ICU ALS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. A middle-age woman with h/o hypertension was found down by her husband. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. She was never seen to be in ventricular fibrillation and was never defibrillated.

STEMI 52

STEMI Coronary ACS Emergency Department 52

The Overrun

APRIL 19, 2021

The call involved a sick patient where the student, who was on the verge of going to boards, pulled out the wrong concentration of epinephrine. You can then add to the learning process by giving them information on definitive care and how what they did fits into the spectrum. Didn’t give it; just took it out of the box.

Paramedic 52

Paramedic OR EMT EMT 52

FOAMfrat

OCTOBER 20, 2023

Likely due to different definitions for hypotension and adverse/major critical events, but the numbers remain higher than we would ever like — Kinda scary when you think about it. Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. What the hell are you to do?!

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

My Paramedic Blog

FEBRUARY 21, 2015

That’s definitely not something I want to be awake for, in fact, it looks painful even when patients have it done under anesthetics. More epinephrine went in via IV. So the nurse drew up the medication as the doctor prepares for the procedure. Every now and then we checked the ECG monitor and checked for pulse. To wake up.

Epinephrine 52

Epinephrine CPR Paramedicine Paramedicine 52

The Skeptics' Guide to EM

NOVEMBER 30, 2024

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. Multiple studies have demonstrated how the administration of epinephrine can improve short-term outcomes, such as return of spontaneous circulation (ROSC).

Epinephrine 244

Epinephrine OR CPR Paramedic 244

FOAMfrat

SEPTEMBER 19, 2024

is positive thanks to the widespread availability of antivenom, relatively short transport times to definitive care, and the U.S.'s These side effects do not contraindicate antivenom administration and can be treated with antihistamines and epinephrine. Rapid transport to definitive care is crucial.

Emergency Department 95

Emergency Department Epinephrine OR Plasma 95

Core EM

APRIL 23, 2025

Definition: Refractory Ventricular Arrhythmias Persistent ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) despite 3 shocks, appropriate CPR, vasopressors, and anti-arrhythmics. Administer epinephrine every 35 minutes. Linked with extremely poor outcomes: survival to discharge ~212%. N Engl J Med.

Defibrillator 130

Defibrillator CPR ALS Epinephrine 130

Core EM

FEBRUARY 14, 2025

Skin flaps, especially those with abnormal color, may have a theoretical risk of increased risk of tissue ischemia and poor wound healing with the use of large amounts of epinephrine-containing local anesthetics. Topical Anesthesia Benefits: Application is quick and relatively painless. Provides effective pain relief over large surface areas.

Epinephrine 130

Epinephrine ED OR Emergency Department 130

Dr. Smith's ECG Blog

APRIL 6, 2025

He was given 50 mcg epinephrine with good response in both heart rate and blood pressure. His heart rate had improved to the 80s after epinephrine administration. He was persistently bradycardic, requiring 2 x 50 mcg epinephrine to maintain HR >60. Epinephrine drip was started and norepinephrine was discontinued.

OR 113

OR Epinephrine CPR ED 113

EMDocs

APRIL 3, 2025

Rhythm: There is definitely a block present. Well, you have two to reach for here, Epinephrine or Dopamine. Both epinephrine and dopamine will exert significant 1 activity at lower doses! If, for some reason, pacing is contraindicated or you cant pace the patient, consider Dopamine or Epinephrine as first line pressors.

Epinephrine 96

Epinephrine EMS OR ED 96

FOAMfrat

NOVEMBER 25, 2024

In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. Definitive care for an intrapartum cardiac arrest is a maternal perimortem cesarian section, which may be performed by any emergency physician. Could this work for the AFE patient?

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105

EMDocs

MARCH 18, 2025

Episode 116: Massive Hemoptysis Definition: Hemoptysis is expectoration of blood from the respiratory tract; ranges from mild with small streaks of blood to cardiopulmonary compromise (1-5). Massive hemoptysis: no clear definition, ranges from 50 mL in a single expectoration to 100 mL in 24 hours to over 1 L in 48 hours.

E-9-1-1 80

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