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Epinephrine and cardiac arrest: what’s the question? How much epinephrine is enough? published a retrospective study in AJEM discussing cumulative epinephrine dosage in cardiac arrest. Garcia et al.
Nick Clarridge runs through the NRP algorithm and delivers the nuggets of wisdom on when and how best to perform chest compressions, give epinephrine and pearls and pitfalls of the algorithm.
A pre-post study conducted in North Carolina compared multi-dose epinephrine with single-dose epinephrine in adult non-traumatic out-of-hospital cardiac arrest (OHCA) patients. Link to article
What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic? We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma?
-Case- A 31-year-old woman rushes into the ED with her lips swelling and a rapidly spreading rash. She was stung by a bee while jogging, and within minutes developed hives, throat tightness, and shortness of breath. On arrival, her vitals are notable for HR of 118 bpm, a BP 82/50 mmHg, and she’s wheezing audibly.
Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergency department, such as septic shock, undifferentiated shock and hypovolemic shock.
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.
to 0.5mg (1mg/mL) IV Bolus: 5 to 20mcg (10mcg/mL) IV Infusion: 1 to 20mcg/min If Poor Response to Conventional Therapy Consider Epinephrine 100mcg IV bolus Norepinephrine infusion 0.1mcg/kg/min Vasopressin 0.01
Navy veteran, he specializes in pediatric trauma care Takehome Points Differentiate Between Traumatic and Medical Cardiac Arrest: The approach to traumatic cardiac arrest is distinct from medical arrest, with hemorrhage control and volume resuscitation taking precedence over standard CPR and epinephrine administration.
Both norepinephrine and epinephrine can be used. Epinephrine is key if there is significant bradycardia. Crystalloid may help, but neurogenic shock may not respond to fluid administration. Alpha 1 agonists are necessary to maintain appropriate blood pressure.
6 Apply direct pressure to the bleeding site with gauze soaked in TXA and epinephrine as a first-line intervention. 7 Epinephrine acts as a local vasoconstrictor, aiding hemostasis, and TXA helps to stabilize clot formation on the exposed tissue and delay hemorrhage progression.
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.
You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine. There is drug paraphernalia scattered around the room. Your partner asks if you want to administer naloxone as well.
University of Maryland Department of Emergency Med
OCTOBER 11, 2023
1,2 Epinephrine autoinjector. Background: It is estimated that nearly 6% of U.S. adults and children report having a food allergy.1,2 Click to view the rest
In this first part of our 2-part series on Cardiac Arrest Controversies Rob Simard, Bourke Tillman, Sara Gray and Scott Weingart discuss with Anton how best to ensure high quality chest compressions, the pros and cons of mechanical CPR, the literature on dual sequential defibrillation and optimizing pad placement, epinephrine vs vasopressin, amiodarone (..)
The post EM Quick Hits 12 AFib Early vs Delayed Cardioversion, Snake Bites, Ovarian Torsion Myths, Crystal Meth, Aortic Dissection, Severe Asthma Meds appeared first on Emergency Medicine Cases.
Intraosseous access is quickly obtained, and a dose of epinephrine is provided. Bystander CPR is being performed. The monitor is hooked up. The paramedics performed high-quality CPR and follow their ACLS protocol. CPR is continued while a supraglottic airway is placed successfully.
SGEM#50 looked at a RCT published in JAMA 2013 looking to see if a vasopressin, steroids, and epinephrine (VSE) protocol for IHCAs could improve survival with favorable neurologic outcome compared to epinephrine alone. I have not seen a validation study published.
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.
Resuscitation recently published an article that assessed the association between intramuscular (IM) epinephrine and survival outcomes, including survival to hospital discharge, survival to hospital admission, and functional survival. Link to article
Buffered lidocaine 1%, epinephrine 1:100,000 with sodium bicarbonate (hydrogencarbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. Epinephrine in Local Anesthetics: This will not make the tip of things fall off (nose, fingers, toes, etc). Reference: Vent et al.
Intensive Care Medicine recently published an article with focus on “Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock” This study was in Paris metropolitan region. The choice of vasopressor is always a topic of controversy regarding post cardiac arrest patients.
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.
Epinephrine was administered to 163 (13.4%) patients. These patients were followed up to 12 hours after hospital admission to determine which vasopressors they received after hospital admission. RESULTS: A total of 1212 patients were enrolled in this study.
We discuss that the palpation technique is poor at determining whether or not a patient has a pulse, that the POCUS pulse is more accurate and as rapid compared to the palpation technique at determining whether or not a patient has a pulse, the difference between true PEA arrest, PseudoPEA and PREM, why epinephrine may be harmful in PEA, Weingart's (..)
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.
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. . < 25 kg = 250 mg up to 3x > 25 kg = 500 mg up to 3x Direct Pressure Always the best way to stop bleeding. Don’t await for fancy meds to arrive from pharmacy.
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.
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.
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.
. #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 (..)
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.
” 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.
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).
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.
As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. EMS arrives on scene and initiates high quality basic life support (BLS). One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF.
University of Maryland Department of Emergency Med
JANUARY 30, 2023
When managing a hypotensive patient who may have some element of cardiogenic shock, it has long been debated whether it is better to start an. Click to view the rest
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. It also did not show an increase in good neurologic outcome in the survivors (78.3% vs. 66.8%, p=0.73). JAMA 2009 * Jacobs et al.
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.
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.
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